title: Lymphovascular invasion and nodal metastasis in intramucosal adenocarcinoma of the esophagus and esophagogastric junction.
abstract: OBJECTIVE
  To evaluate the tumor parameters predictive of lymphovascular invasion (LVI) and nodal metastases in intramucosal adenocarcinoma (IMAC) of the esophagus and esophagogastric junction.
  
  
  METHODS
  In all, 171 cases of IMAC from esophagectomy database (1986-2009) were reviewed. LVI was evaluated on HE and by immunohistochemistry stain for D2-40 (in selected cases). Univariate analysis was performed to identify predictors for LVI (in this cohort) and nodal metastasis (for pooled data from literature review).
  
  
  RESULTS
  Altogether 150 IMAC were included in the study after histology review; 7 (4.7%) showed LVI and one (0.7%) had nodal metastasis. LVI-positive IMAC were thicker (tumor thickness 3.0 ± 2.8 mm vs 1.3 ± 1.2 mm, P = 0.01), and more likely to invade the outer muscularis mucosae (M3) (P = 0.004), be poorly differentiated (P < 0.001), and to show a nodular or plaque-like lesion (P = 0.04) compared with LVI-negative IMAC. Patients' age, gender, the frequency of tumor multifocality, ulceration and tumor size were not significantly different between these two groups. The pooled rates of LVI and nodal metastases in IMAC from five published studies and this cohort were 6.0% (range 2.9-16.7%) and 3.4% (range 0-10.0%), respectively. Pooled analysis of studies with histology review showed that LVI in IMAC was associated with a nodal metastases rate of 27.3%.
  
  
  CONCLUSIONS
  For IMAC of the esophagus and esophagogastric junction, LVI is associated with tumor thickness, M3 invasion, poor differentiation and the presence of nodular or plaque-like lesion; by pooled analysis, it is associated with a risk of nodal metastasis of 27.3%.
authors.affiliation: Department of Surgery, Second Military Medical University, Shanghai, China.
authors.forename: Zhi Gang
authors.initials: ZG
authors.lastname: Li
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.forename: Hong
authors.initials: H
authors.lastname: Shi
authors.forename: Hao
authors.initials: H
authors.lastname: Xie
authors.forename: John R
authors.initials: JR
authors.lastname: Goldblum
authors.forename: Prashanthi N
authors.initials: PN
authors.lastname: Thota
authors.forename: Xiuli
authors.initials: X
authors.lastname: Liu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary; D000368:Aged; D004938:Esophageal Neoplasms / Q000473:pathology*; D016629:Esophagectomy / Q000706:statistics & numerical data; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness
keywords: esophageal neoplasms; esophagogastric junction; intramucosal adenocarcinoma; lymphatic metastasis; lymphovascular invasion