Curative Resection of T1 Colorectal Carcinoma: Risk of Lymph Node Metastasis and Long-Term Prognosis

PURPOSE The features of T1 colorectal adenocarcinoma and the risk determination of lymph node metastasis were reviewed. Prognostic factors were assessed to verify whether the risk of lymph node metastasis would influence the long-term prognosis.METHODS Patients undergoing curative resection of T1 colorectal adenocarcinoma at the Taipei Veterans General Hospital from December 1969 to August 2002 were retrospectively studied. Patients with synchronous colorectal cancer, distant metastasis, familiar adenomatous polyposis, or inflammatory bowel disease were excluded. The associations between lymph node metastasis and clinicopathologic variables were evaluated univariately using chi-squared test, Fisher’s exact test, or Student’s t -test, and multivariately using logistic regression. Univariate analysis by the log-rank test and multivariate analysis by Cox regression hazards model determined the factors influencing the overall survival.RESULTS A total of 159 patients were included. Sixteen patients (10.1 percent) had lymph node metastasis. The risk of lymph node metastasis included histologic grade (P = 0.005), lymphatic vessel invasion (P = 0.023), inflammation around cancer (P = 0.049), and budding at the invasive front of tumor (P = 0.022). Age (P = 0.001) and number of total sampling lymph nodes (P < 0.0001) were found to be the factors influencing the overall survival.CONCLUSIONS Variables that predict lymph node metastasis in surgically resected T1 colorectal carcinoma may not impact the long-term prognosis.Supported by a grant from the Research Foundation of Taipei Veterans General Hospital.     

Immunohistochemical molecular markers as predictors of curability of endoscopically resected submucosal colorectal cancer

AIM： To clarify the usefulness of immunohistochemical molecular markers in predicting lymph node metastasis of submucosal colorectal cancer.
METHODS： We examined microvessel density, lymphatic vessel density, the Ki-67 labeling index, expression of MUC1 and Matrix metalloproteinase-7 （MMP-7） in tumor cells, and expression of cathepsin D in stromal cells at the invasive front by immunostaining of samples resected from 214 patients with submucosal colorectal cancer. Pathologic features were assessed on hematoxylin-eosinstained samples. We evaluated the relations between clinicopathologic/immunohistochemical features and lymph node metastasis.
RESULTS： Lesions of the superficial type, with an unfavorable histologic grade, budding, lymphatic involvement, high microvessel density （≥ 40）, high lymphatic vessel density （≥9）, high Ki-67 labeling index （≥ 42）, and positivity of MUC1, cathepsin D, and MMP-7 showed a significantly high incidence of lymph node metastasis. Multivariate analysis revealed that high microvessel density, unfavorable histologic grade, cathepsin D positivity, high lymphatic vessel density, superficial type, budding, and MUC1 positivity were independent risk factors for lymph node metastasis.A combined examination with four independent immunohistochemical markers （microvessel density, cathepsin D, lymphatic vessel density, and MUC1） revealed that all lesions that were negative for all markers or positive for only one marker were negative for lymph node metastasis.
CONCLUSION： Analysis of a combination of immuno- histochemical molecular markers in endoscopically resected specimens of submucosal colorectal cancer allows prediction of curability regardless of the pathologic features visible of hematoxylin-eosin-stained sections.     

Invasive front of colorectal cancer： Dynamic interface of pro-/anti-tumor factors

Tumor-host interaction at the invasive front of colorectal cancer represents a critical interface encompassing a dynamic process of de-differentiation of colorectal carcinoma cells known as epithelial mesenchymal transition (EMT). EMT can be identified histologically by the presence of "tumor budding", a feature which can be highly specific for tumors showing an infiltrating tumor growth pattern. Importantly, tumor budding and tumor border configuration have generated considerable interest as additional prognostic factors and are also recognized as such by the International Union Against Cancer. Evidence seems to suggest that the presence of tumor budding or an infiltrating growth pattern is inversely correlated with the presence of immune and inflammatory responses at the invasive tumor front. In fact, several tumor-associated antigens such as CD3, CD4, CD8,CD20, Granzyme B, FOXP3 and other immunological or inflammatory cell types have been identified as potentially prognostic in patients with this disease. Evidence seems to suggest that the balance between pro-tumor(including budding and infiltrating growth pattern) and anti-tumor (immune response or certain inflammatory cell types) factors at the invasive front of colorectal cancer may be decisive in determining tumor progression and the clinical outcome of patients with colorectal cancer. On one hand, the infiltrating tumor border con-figuration and tumor budding promote progression and dissemination of tumor cells by penetrating the vascular and lymphatic vessels. On the other, the host attempts to fend off this attack by mounting an immune response to protect vascular and lymphatic channels from invasion by tumor buds. Whereas standard pathology reporting of breast and prostate cancer involves additional prognostic features, such as the BRE and Gleason scores, the ratio of pro- and anti-tumor factors could be a promising approach for the future development of a prognostic score for patients with colorectal cancer which could complement tumor node metastasis staging to improve the clinical management of patients with this disease.     

Predictive Histopathologic Factors for Lymph Node Metastasis in Patients With Nonpedunculated Submucosal Invasive Colorectal Carcinoma

PURPOSE Risk factors for lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma remain to be characterized. This study examines the relationship between lymph node metastasis and clinicopathologic factors in nonpedunculated submucosal invasive colorectal carcinoma.METHODS The study cohort comprised 155 patients who had undergone surgical treatment for nonpedunculated submucosal invasive colorectal carcinoma. The clinicopathologic factors investigated included gender, age, tumor location, macroscopic type, tumor size, histologic type and grade, intramucosal growth pattern, lymphatic invasion, venous invasion, degree of focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and the depth and width of submucosal invasion.RESULTS Lymph node metastases were found in 19 patients (12.3 percent). Univariate analysis showed that lymphatic invasion, focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and depth of submucosal invasion all had a significant influence on lymph node metastasis. Multivariate analysis showed lymphatic invasion (P = 0.014) and high-grade focal dedifferentiation at the submucosal invasive front (P = 0.049) to be independent factors predicting lymph node metastasis. No lymph node metastasis was found in tumors with a depth of submucosal invasion of <1.3 mm.CONCLUSIONS Lymphatic invasion and high-grade focal dedifferentiation at the submucosal invasive front are important predictors of lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma. Depth of submucosal invasion can be used as an identifying marker for patients who do not require subsequent surgery after endoscopic resection.Supported in part by a grant-in-aid for cancer research from the Ministry of Health and Welfare of Japan.     

Risk Factors for Occult Lymph Node Metastasis of Colorectal Cancer Invading the Submucosa and Indications for Endoscopic Mucosal Resection

Purpose Although risk factors for histologically overt lymph node metastasis in patients with early-stage colorectal cancer have been clarified, the risk factors for occult lymph node metastasis are not clear. This study was designed to clarify risk factors for lymph node metastasis, including occult metastasis, in patients with colorectal cancer invading the submucosa and to determine the criteria for endoscopic resection of early colorectal cancer. Methods The risk factors for lymph node metastasis, including occult metastasis, were analyzed in 86 cases of surgically resected colorectal cancer invading the submucosa. The lymph nodes were assessed by immunohistochemistry with cytokeratin antibody CAM5.2. Results The frequencies of overt and occult metastasis to the lymph nodes were 13 percent (11/86) and 13 percent (10/75), respectively. Multivariate analysis showed vascular invasion (P = 0.001) and tumor budding (P = 0.003) to be independent risk factors for lymph node metastasis, including occult metastasis. For tumors with submucosal invasion ≤1,000 μm, no lymph node metastasis was found. The frequencies of lymph node metastasis for tumors with submucosal invasion of 1,000 to 2,000 μm and >2,000 μm were 21 and 37 percent, respectively. In considering combinations of risk factors, there was no lymph node metastasis in tumors having neither vascular invasion nor tumor budding and submucosal invasion of ≤3,000 μm. Conclusions Vascular invasion, tumor budding, and the degree of submucosal invasion were significant risk factors for lymph node metastasis, including occult metastasis. These three factors can be used in combination to identify patients requiring additional surgery after endoscopic resection. Supported in part by a Grant-in-Aid for Scientific Research (no. 15390401) from the Japanese Ministry of Education, Science, and Culture. Presented at the Congress of Japan Surgery Society, Tokyo, Japan, March 29 to 31, 2006. Reprints are not available.     

Actual number of tumor budding as a new tool for the individualization of treatment of T1 colorectal carcinomas

BACKGROUND AND AIM: Treatment of T1 colorectal carcinomas, either local excision including endoscopic polypectomy or radical surgery, has always been problematic in everyday practice. Although previous studies have revealed that tumor budding at the invasive margin can be a marker for the malignant potential of T1 colorectal carcinomas, the evaluation of tumor budding has not been standardized as yet. In the present study, we attempted to apply the actual number of tumor budding units for the individualization of treatment in T1 colorectal carcinomas. METHODS: In 76 T1 colorectal carcinomas, associations between lymph node metastasis and clinicopathological parameters were examined statistically. A mathematical formula for predicting the risk of lymph node metastasis was constructed and decision analysis was attempted to determine individually the indication for additional surgery after endoscopic mucosal resection of T1 colorectal carcinomas. RESULTS: Of the clinicopathological parameters examined, multivariate analysis showed that the actual number of tumor budding units alone was significantly associated with lymph node metastasis. The probability of lymph node metastasis was calculated as Z = 0.07 x (budding counts) - 3.726, probability = 1/1 + e(-Z). The more the budding counts, the higher the probability of lymph node metastasis. This formula was able to accurately predict lymph node metastasis in successive cases. The actual number of tumor budding units can be applied to decision analysis in determining an indication for additional surgery after endoscopic mucosal resection of T1 colorectal carcinomas. CONCLUSIONS: The actual number of tumor budding units may be useful in the decision making for patient-oriented treatment of T1 colorectal carcinomas.     

Evaluation of Tumor Cell Dissociation as a Predictive Marker of Lymph Node Metastasis in Submucosal Invasive Colorectal Carcinoma

PURPOSE Tumor cell dissociation—the histologic finding of small solid carcinoma cell clusters and groups of dissociated dedifferentiated carcinoma cells at the invasive front–is related to tumor metastasis and patient prognosis. However, few previous reports have examined tumor cell dissociation in submucosal invasive colorectal carcinoma. We investigated the relation between tumor cell dissociation and lymph node metastasis in submucosal invasive colorectal carcinoma. We also examined immunohistochemical expression of E-cadherin and beta-catenin in submucosal invasive colorectal carcinoma.METHODS Submucosal invasive colorectal carcinoma tissue samples from 20 patients with lymph node metastasis and 100 patients without lymph node metastasis were evaluated. Sections stained with hematoxylin and eosin were evaluated for tumor cell dissociation. Immunohistochemistry was used to determine the expression and cellular distribution of E-cadherin and beta-catenin.RESULTS Tumor cell dissociation was more frequently identified in submucosal invasive colorectal carcinoma cases with lymph node metastasis than in those without lymph node metastasis (P = 0.0001). Decreased membranous expression of E-cadherin occurred more frequently in submucosal invasive colorectal carcinoma cases with lymph node metastasis than in those without lymph node metastasis (P = 0.025). Nuclear expression of beta-catenin tended to be present in submucosal invasive colorectal carcinoma cases with lymph node metastasis (P = 0.063). Decreased membranous expression of E-cadherin occurred more frequently in submucosal invasive colorectal carcinoma cases with tumor cell dissociation than in those without tumor cell dissociation (P = 0.0023).CONCLUSIONS Our results suggest that there is a relation between tumor cell dissociation and lymph node metastasis in submucosal invasive colorectal carcinoma. Tumor cell dissociation formation might be related to abnormal expression patterns of E-cadherin and beta-catenin in submucosal invasive colorectal carcinoma. Tumor cell dissociation and decreased membranous expression of E-cadherin would be important predictive markers for lymph node metastasis in submucosal invasive colorectal carcinoma.Presented at the 93rd Japanese Society of Pathology, Sapporo, Japan, June 9 to 11, 2004.     

Loss of standard type of CD44 expression in invaded area as a good indicator of lymph-node metastasis in colorectal carcinoma

PURPOSE: Recent advances have made possible the treatment of small invasive colorectal cancer by means of polypectomy or endoscopic mucosal resection. CD44 expression in cancer cells was identified as an indicator of lymph-node metastasis, which could be evaluated in specimens removed by colonoscopy. METHODS: The correlation between lymph-node metastasis and the expression of standard-type CD44 in cancer cells was examined immunohistologically using the invaded cancer cells of 61 tissue samples of superficially invasive colorectal cancer. We defined the above as invasive cancer restricted within the colorectal wall. Of the 61 samples, 31 had submucosal invasion and 30 had muscular invasion. RESULTS: Standard-type CD44 expression in the area of invasion in cases with lymph-node metastasis was remarkably down-regulated. In 43 cases with no lymph-node metastasis, 36 (83.7 percent) of patients had CD44 expression in invaded cells, whereas only two of 18 cases (11.1 percent) with lymph-node metastasis had expression of standard-type CD44 in the same area (P < 0.0001). A total of 69.6 percent (16/23) of patients with loss of standard-type CD44 expression in invaded sites were found to have positive metastasis in the lymph nodes. These results suggest that standard-type CD44 in invasive colon cancer cells could suppress metastasis to the regional lymph nodes. CONCLUSION: In cases of invasive colorectal cancer, the loss of standard-type CD44 expression in the invaded area is a sensitive marker for metastasis to the lymph nodes. Further investigation with larger patient groups is required to clarify the reliability of loss of standard-type CD44 expression as an indicator for additional surgery after endoscopic resection of submucosal invasive colorectal carcinoma.     

Budding as a useful determinant of the optimal treatment for T1 rectal carcinomas

BACKGROUND/AIMS: If a locally excised specimen has poorly differentiated or undifferentiated histology, positive vascular invasion, or massive invasion to the cut end or a positive margin, additional surgery is recommended for the treatment of T1 rectal carcinoma. However, positive predictive values of these histological criteria are low. This study was undertaken to clarify more reliable risk factor(s) for lymph node metastasis in T1 rectal carcinomas. METHODOLOGY: In 58 patients with T1 rectal carcinoma undergoing local excision or radical surgery, the associations between lymph node metastasis or intrapelvic recurrence and clinicopathological features were studied using multiple regression analysis with special reference to tumor budding at the invasive front. RESULTS: Lymph node metastasis was observed in 1 of 9 patients undergoing additional bowel resection after local excision, and in 2 of 24 patients undergoing radical surgery alone. Intrapelvic extrarectal recurrence was observed in 3 of 25 patients undergoing local excision alone. Logistic regression analysis revealed that budding at the invasive front alone was significantly associated with lymph node metastasis or intrapelvic recurrence (p = 0.0484). CONCLUSIONS: Additional bowel resection with lymph node dissection should be recommended for locally excised T1 rectal carcinoma with budding at the invasive front.     

结直肠癌肺转移的外科治疗

结直肠癌是我国的常见恶性肿瘤,发病率居第三位。约20%的结直肠癌初诊时就伴有远处转移,其中肺是最常见的转移部位之一。大量文献表明,对于结直肠癌伴有局限性肺转移的患者手术切除转移病灶,术后的5年生存率为21%～64%。存在其他可切除转移灶并不是手术禁忌。对于手术耐受良好的肺部转移瘤术后复发的患者,再次手术仍可生存获益。距离病灶0.5cm～1.0cm楔形切除是肺外周型病灶的经典术式。对于结直肠癌肺转移瘤手术胸腔淋巴结清扫仍有不同观点。目前公认的结直肠癌肺转移预后不良的因素包括：多发肺转移瘤、癌胚抗原水平升高、胸内淋巴结转移、无瘤间期较短。基于精准医学的个体化治疗将是未来进一步改善预后的关键。     

Budding as a risk factor for lymph node metastasis in pT1 or pT2 well-differentiated colorectal adenocarcinoma

PURPOSE: Lymph node metastasis is an important indicator of tumor stage and prognosis in pT1 and pT2 colorectal adenocarcinomas. Lymphovascular invasion is an established risk factor of lymph node metastasis, whereas budding at the invasive front of tumors is also reported to correlate with lymph node metastasis. We examined whether the coexistence of lymphovascular invasion and budding provides any better information than lymphovascular invasion alone in the prediction of lymph node metastasis of pT1 or pT2 well-differentiated colorectal adenocarcinomas. METHODS: Surgically resected specimens of 101 pT1 or pT2 well-differentiated colorectal adenocarcinomas were studied. Using sections stained with hematoxylin-eosin, we examined lymphovascular invasion and budding according to Morodomis definition. RESULTS: Lymphovascular invasion was present in 39 lesions (38 percent), whereas budding was found in 42 lesions (41 percent). Budding was more frequently detected in pT2 tumors than in pT1 tumors. The presence of budding significantly correlated with lymphovascular invasion. Sensitivity, specificity, positive predictive value, and negative predictive value of lymphovascular invasion alone for lymph node metastasis were 79, 76, 34, and 96 percent, respectively, whereas those of the combination of lymphovascular invasion and budding (either lymphovascular invasion or budding) were 93, 52, 24, and 98 percent, respectively. CONCLUSION: Because the risk of lymph node metastasis in pT1 or pT2 well-differentiated colorectal adenocarcinomas having neither lymph node metastasis nor budding is very low, budding in combination with lymphovascular invasion seems to be a simple and inexpensive pathologic marker in predicting lymph node metastasis. Therefore, the presence or absence of budding should be examined in the routine pathologic diagnosis of pT1 or pT2 well-differentiated colorectal adenocarcinomas.     

Actinin-4 increases cell motility and promotes lymph node metastasis of colorectal cancer

BACKGROUND & AIMS: Enhanced motility of cancer cells by remodeling of the actin cytoskeleton seems crucial in the process of cancer invasion and metastasis. We previously identified an actin-binding protein, actinin-4, as a new biomarker of cancer invasion and an indicator of prognosis for patients with breast cancer. However, its involvement in the mechanisms of cancer invasion and metastasis remains undetermined. The current study tested the role of actinin-4 in the motility and metastatic potential of colorectal cancer cells. METHODS & RESULTS: Quantitative immunofluorescence histochemistry showed that the expression level of the actinin-4 protein was increased in 73.1% (19/26) of the cases of colorectal cancer over the corresponding normal intestinal epithelium. The increased expression of actinin-4 was most significant in dedifferentiated cancer cells at the invasive front. A colorectal cancer cell clone capable of inducing actinin-4 using the tetracycline-regulatory system (designated DLD1 Tet-off ACTN-4) was established. Upon the induction of actinin-4, DLD1 Tet-off ACTN-4 cells spread filopodia and significantly increased their motility ( P = .00027); actinin-4 protein was concentrated at the leading edges of these actin-rich podia. When injected into the mesocecum of severe combined immunodeficient mice, DLD1 Tet-off ACTN4 cells, but not the control cells, metastasized into regional mesenteric lymph nodes, resembling the behavior of clinical cancers. The expression of actinin-4 in focally dedifferentiated cancer cells at the invasive front was significantly correlated with the frequency of lymph node metastasis of colorectal cancer ( P = .038). CONCLUSIONS: Actinin-4 actively increases cell motility and promotes lymph node metastasis of colorectal cancer.     

探讨癌结节在结直肠癌患者术后病理分期中的意义及其对预后的价值研究

目的研究结直肠癌手术患者术后病理中癌结节的检出与患者预后的关系,探讨更加详细、合理的分期方法。 方法收集2012年1月至2013年12月于安徽医科大学第一附属医院普外科行结直肠癌切除术的361例患者的临床及随访资料,采用Kaplan-Meier生存曲线比较生存差异,COX单因素和多因素分析影响结直肠癌患者预后的相关因素。 结果术后病理中癌结节检出与否和肿瘤的分化程度、肿瘤的浸润深度（T）、pTNM分期、CEA、CA19-9相关,差异具有统计学意义（均P<0.05）;单因素分析癌结节阴性患者生存时间长于癌结节阳性患者,差异具有统计学意义（χ²=10.805,P<0.05）;将N0、N1c、N1和N2的患者进行生存比较,发现N1c和N1的患者之间差异无统计学意义（χ²=0.580,P>0.05）;随着癌结节数目的增加,患者的生存预后越差;当把癌结节当成转移淋巴结时,得到新的分期与第八版TNM分期的生存比较存在差异：当对癌结节数目、转移淋巴结数目和总检出淋巴结数目进行研究时发现,随着阳性结节比值（癌结节数＋转移淋巴结数）/（癌结节数＋病理检出淋巴结总数）的增加,患者的预后也随之变差（59.4 vs. 58.2 vs. 36.0 vs. 28.7,χ²=15.389;P=0.002）。 结论癌结节的状态是影响结直肠癌患者预后的重要因素,将癌结节及转移淋巴结均定义为阳性结节后,阳性结节比值越高的患者预后越差;阳性结节比值可作为评估结直肠癌患者TNM分期中的重要补充,为指导日后治疗提供更准确的依据。     

乙肝表面抗原等因素对结直肠癌肝转移的影响

目的本研究将探讨乙肝表面抗原（HBsAg）等多项临床因素对结直肠癌肝转移的影响,为进一步治疗结直肠癌肝转移提供新的研究思路及方向。 方法回顾性分析青岛大学医学院附属医院2010年1月至2011年6月病理证明的结直肠癌患者892例。收集患者的相关临床资料（包括乙肝表面抗原、年龄、术前相关实验室检查、术后病理结果等）,研究是否会影响肝转移的发生。 结果结直肠癌是否发生肝转移两组患者在性别、年龄、肿瘤发生部位、大小、病理组织类型、是否造口、血清白蛋白、总胆红素及谷草转氨酶等方面相比,差异均无统计学意义（χ²=0.359,Z=-1.631,χ²=0.003,χ²=1.223,χ²=0.619,χ²=0.516,Z=-3.235,Z=-0.106,Z=-0.328;均P>0.05）。HBsAg阳性较阴性患者发生肝转移几率明显降低,差异有统计学意义（χ²=5.809,P<0.05）。另外,肝转移与分化水平（χ²=14.165,P<0.01）、浸润程度（χ²=17.808,P<0.01）以及淋巴结转移数目（χ²=41.798,P<0.01）有关,差异均有统计学意义。多因素logistic回归分析结果表示乙肝病毒表面阳性患者肝转移发生低,而低分化、浸润程度高、淋巴结转移多者肝转移率高。 结论乙型肝炎病毒表面抗原阳性会降低肝转移的发生几率。分化程度越低、浸润程度越高、淋巴结转移数多,越容易发生肝转移。     

Tumor Budding as an Indicator of Isolated Tumor Cells in Lymph Nodes From Patients With Node-Negative Colorectal Cancer

PURPOSE Isolated tumor cells are often found in the regional lymph nodes of colorectal cancer, although their prognostic significance has not been established yet. This study was performed to investigate the correlation between the presence of isolated tumor cells in lymph nodes and the histopathologic characteristics of colorectal cancers and, thus, to determine which factors are associated with isolated tumor cells.METHODS We used immunohistochemistry with anticytokeratin antibody to examine 2,784 lymph nodes in 109 patients with node-negative colorectal cancers. The clinicopathologic features of the tumors with isolated tumor cells were compared with those without isolated tumor cells. The frequency, number, and level of the isolated tumor cells also were assessed.RESULTS Isolated tumor cells were detected in 335 lymph nodes (12 percent) from 71 patients (65.1 percent). Those tumors having isolated tumor cells in lymph nodes, compared with those not having isolated tumor cells, were characterized by large tumor size, high T stage (pT3 and pT4), angiolymphatic invasion, perineural invasion, absence of peritumoral lymphocytic response, microsatellite instability-negative phenotype, and tumor budding. Multivariate analysis showed that those factors independently associated with the presence of isolated tumor cells were high T stage, tumor budding, and microsatellite instability-negative phenotype. Among the 71 patients with high T stage and microsatellite instability-negative phenotype, tumors with isolated tumor cells were characterized by a high frequency of tumor budding compared with tumors without isolated tumor cells (85 vs. 36.4 percent). In a further study, the degree of budding, which was assessed by an immunohistochemical study of 2 chain of laminin-5, was closely related to the number and location of isolated tumor cells. Moreover, we found that most of the isolated tumor cells in the regional lymph nodes also expressed 2 chain of laminin-5.CONCLUSIONS Our results suggested that isolated tumor cells are derived from undifferentiated cancer cells or small clusters (budding) at the invasive front. Thus, tumor budding may be used as an indicator of isolated tumor cells in lymph nodes with node-negative colorectal cancers.Supported by a grant from the Seoul National University Bundang Hospital Research Fund, Seongnam, Korea.Presented at the meeting of The Korean Society of Pathologists, Seoul, Korea, October 30 to November 1, 2003.     

内镜超声引导下细针穿刺抽吸术在纵隔病变诊断中的应用

目的 初步探讨内镜超声引导下细针穿刺抽吸术(EUS-FNA)在纵隔肿大淋巴结、纵隔不明原因占位定性诊断及肺癌N分期中的应用价值.方法 应用22 G穿刺针对61例患者经食管行EUS.FNA,穿刺物均行病理及细胞学检查.结果 EUS·FNA诊断阳性率为93.4%(57/61),细胞学及病理诊断阳性率分别为85.2%(52/61)和83.6%(51/61).100.0%(26/26)临床疑诊肺癌纵隔淋巴结转移而经支气管镜等检查未能提供病理或细胞学证据者均通过EUS-FNA得到诊断,其中21例诊断为肺癌、5例排除肺癌诊断为良性疾病;86.4%(19/22)纵隔不明原因占位明确定性;85.7%(6/7)有恶性肿瘤病史影像学检查疑诊纵隔淋巴结转移者,EUS-FNA病理及细胞学结果 支持转移;6例经支气管镜检查已获得明确病理细胞学诊断的肺癌病例但影像学提示纵隔淋巴结肿大,为明确N分期行EUS-FNA,结果 均为阳性,改变了原计划治疗方案.本组无一例EUS-FNA相关并发症发生.结论 对于明确纵隔肿大淋巴结、纵隔不明原因占位定性诊断及肺癌N分期,EUS-FNA是一种较为安全、有效的诊断方法.     

Computed tomography and magnetic resonance imaging evaluation of lymph node metastasis in early colorectal cancer

AIM: To assess the role of computed tomography(CT) and magnetic resonance imaging(MRI) and establish imaging criteria of lymph node metastasis in early colorectal cancer.METHODS: One hundred and sixty patients with early colorectal cancer were evaluated for tumor location, clinical history of polypectomy, depth of tumor invasion, and lymph node metastasis. Two radiologists assessed preoperative CT and/or MRI for the primary tumor site detectability, the presence or absence of regional lymph node, and the size of the largest lymph node. Demographic, imaging, and pathologic findings were compared between the two groups of patients based on pathologic lymph node metastasis and optimal size criterion was obtained.RESULTS: The locations of tumor were ascending, transverse, descending, sigmoid colon, and rectum. One hundred and sixty early colorectal cancers were classified into 3 groups based on the pathological depth of tumor invasion; mucosa, submucosa, and depth unavailable. A total of 20(12.5%) cancers with submucosal invasion showed lymph node metastasis. Lymph nodes were detected on CT or MRI in 53 patients. The detection rate and size of lymph nodes were significantly higher(P = 0.000, P = 0.044, respectively) in patients with pathologic nodal metastasis than in patients without nodal metastasis. Receiver operating curve analysis showed that a cut-off value of 4.1 mm is optimal with a sensitivity of 78.6% and specificity of 75%.CONCLUSION: The short diameter size criterion of≥ 4.1 mm for metastatic lymph nodes was optimal for nodal staging in early colorectal cancer.