title: Lymph node metastasis in early esophageal adenocarcinoma.
abstract: OBJECTIVE
  To accurately document the incidence of lymph node metastases (LNM) in early esophageal adenocarcinoma with regard to the depth of invasion of the mucosa or submucosa.
  
  
  BACKGROUND
  Endoscopic therapy is now being proposed as a viable treatment for submucosal esophageal adenocarcinoma. If such treatments are appropriate, then the risk of LNM must be shown to be low in these tumors.
  
  
  METHODS
  One hundred nineteen consecutive patients underwent radical esophagectomy alone for treatment of superficial esophageal adenocarcinoma or high-grade dysplasia. The resection specimens were analyzed by an expert gastrointestinal pathologist and the presence of LNM and the depth of tumor invasion were recorded. Depth of invasion was classified as either confined to the mucosa, the first third of the submucosa, the middle third of the submucosa, or the final third of the submucosa.
  
  
  RESULTS
  Fifty-four patients had high-grade dysplasia or tumors confined to the mucosa with no evidence of LNM (0/54, 0%), 65 patients had tumor invading the submucosa with 8 patients having LNM (8/65, 12%). Subclassification of submucosal invasion showed that 5 of 22 "first third of the submucosa" tumors had LNM (23%), 1 of 24 "middle third of the submucosa" tumors had LNM (4%), and 2 of 19 "final third of the submucosa" tumors had LNM (11%).
  
  
  CONCLUSIONS
  Invasion of the submucosa is associated with significant risk of LNM. Patients with submucosal invasion are not suitable for endoscopic treatment and surgical resection remains the gold standard treatment for patients with submucosal adenocarcinoma who are fit to undergo the procedure.
authors: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. michael.griffin@nuth.nhs.uk
authors: S M
authors: SM
authors: Griffin
authors: A D
authors: AD
authors: Burt
authors: N A
authors: NA
authors: Jennings
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D009361:Neoplasm Invasiveness