Measurement of Depth of Invasion, Submucosal and Lymphovascular Invasion (LVI) Predicts Lymph Node (LN) Involvement in T1 Esophageal Adenocarcinoma (EAC). Invasion of Duplicated Muscularis Mucosae (MM) Has Similar Risk of LN Involvement as Mucosal Invasion.
Jeannelyn S Estrella, Wayne Hofstetter, Arlene M Correa, Jaffer Ajani, Stephen Swisher, Asif Rashid, Dipen Maru. U.T. M.D. Anderson Cancer Center, Houston, TX
Background: The major challenge in treatment of T1 EAC is to decide who should be treated by endoscopic mucosal resection or limited esophagectomy. Measurement of depth of invasion has prognostic value in other tumor sites but has not been assessed in EAC. Recent studies have shown duplicated MM in EAC but potential for LN metastasis in tumors invading the duplicated MM space is yet to be addressed.
Design: H&E from esophagectomy from 91 patients (M/F 84/7, average age 63 yrs.) with T1 EAC were evaluated for tumor differentiation, tumor configuration (exophytic or ulcerated), depth of invasion (mucosa, duplicated MM or submucosa), LVI and depth of invasion in millimeter (from the top of the tumor to deepest focus of invasion). Depth of invasion in millimeter and invasion into three layers were reviewed by second pathologist for interobserver variability. Both pathologists were blinded from LN status. Interobserver variability was assessed by kappa statistics/Pearson coefficient and logistic regression was used to correlate parameters with LN metastases in univariate model.
Results: LN metastases were observed with mucosal invasion (n=2), with submucosal invasion (n=9), and LVI (n=7), none with tumors in duplicated MM space.
|N||p||Odds Ratio||95% CI*|
|Depth of Invasion||91||0.006||1.04||1.01-1.07|
|Mucosa (LP or Inner MM)* (reference)||27|
|Mucosa* and Duplicated MM* (reference)||64|