title: Early clinical esophageal adenocarcinoma (cT1): Utility of CT in regional nodal metastasis detection and can the clinical accuracy be improved?
abstract: BACKGROUND
  Treatment of early esophageal cancer depends on the extent of the primary tumor and presence of regional lymph node metastasis.(RNM). Short axis diameter>10mm is typically used to detect RNM. However, clinical determination of RNM is inaccurate and can result in inappropriate treatment. Purpose of this study is to evaluate the accuracy of a single linear measurement (short axis>10mm) of regional nodes on CT in predicting nodal metastasis, in patients with early esophageal cancer and whether using a mean diameter value (short axis+long axis/2) as well as nodal shape improves cN designation.
  
  
  METHODS
  CTs of 49 patients with cT1 adenocarcinoma treated with surgical resection alone were reviewed retrospectively. Regional nodes were considered positive for malignancy when round or ovoid and mean size>5mm adjacent to the primary tumor and>7mm when not adjacent. Results were compared with pN status after esophagectomy.
  
  
  RESULTS
  18/49 patients had pN+ at resection. Using a single short axis diameter>10mm on CT, nodal metastasis (cN) was positive in 7/49. Only 1 of these patients was pN+ at resection (sensitivity 5%, specificity 80%, accuracy 53%). Using mean size and morphologic criteria, cN was positive in 28/49. 11 of these patients were pN+ at resection (sensitivity 61%, specificity 45%, accuracy 51%). EUS with limited FNA of regional nodes resulted in 16/49 patients with pN+ being inappropriately designated as cN0.
  
  
  CONCLUSIONS
  Evaluation of size, shape and location of regional lymph nodes on CT improves the sensitivity of cN determination compared with a short axis measurement alone in patients with cT1 esophageal cancer, although clinical utility is limited.
authors.affiliation: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States. Electronic address: slbetancourt@mdanderson.org.
authors.forename: Sonia L
authors.initials: SL
authors.lastname: Betancourt Cuellar
authors.affiliation: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States. Electronic address: bsabloff@mdanderson.org.
authors.forename: Bradley
authors.initials: B
authors.lastname: Sabloff
authors.affiliation: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States. Electronic address: bcarter2@mdanderson.org.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Carter
authors.affiliation: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States. Electronic address: mfbenveniste@mdanderson.org.
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Benveniste
authors.affiliation: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States. Electronic address: amcorrea@mdanderson.org.
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.affiliation: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States. Electronic address: dmaru@mdanderson.org.
authors.forename: Dipen M
authors.initials: DM
authors.lastname: Maru
authors.affiliation: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States. Electronic address: jajani@mdanderson.org.
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.affiliation: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States. Electronic address: jerasmus@mdanderson.org.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Erasmus
authors.affiliation: The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, United States. Electronic address: whofstetter@mdanderson.org.
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D000368:Aged; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT; Early clinical esophageal adenocarcinoma; Regional nodal disease; Utility