Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea.
Hum Pathol. 2013 Oct;44(10):2132-8. doi: 10.1016/j.humpath.2013.04.006. Epub 2013 Jun 24.
Endoscopic submucosal dissection (ESD) is widely accepted as an appropriate treatment modality for early gastric cancer (EGC). Accepted indications for ESD are mostly based on the risk of lymph node (LN) metastasis in EGC. The presence of lymphovascular emboli (LVEs) is the most important risk factor for predicting LN metastasis, but the criteria for diagnosing LVEs are inconsistent and controversial. Here, we defined LVE as the presence of tumor cells within a space according to the following criteria: (1) red cells or lymphocytes surrounding the tumor cells, (2) an endothelial cell lining, and (3) attachment to the vascular wall. We reviewed a series of 102 patients with EGC who underwent gastrectomy after ESD, evaluated the definition of LVE, counted the number of LVEs in ESD specimens, and validated the significance of the definition and number of LVEs with regard to the presence of LN metastasis in gastrectomy specimens using receiver operating characteristic (ROC) curve analysis. Overall, 13 instances (12.7%) of LN metastasis were identified among 102 patients with EGC who underwent gastrectomy after ESD. The LN metastasis-positive group showed higher numbers of definite (4.46 ± 2.45 versus 0.19 ± 0.07), suspicious (3.15 ± 0.76 versus 0.62 ± 0.14), and probable (1.62 ± 0.43 versus 0.43 ± 0.10) LVEs in ESD specimens than the LN metastasis-negative group. In ROC analysis, the area under the ROC curve was 0.851 (95% confidence interval [CI], 0.711-0.991) for definite LVEs, compared with 0.82 (95% CI, 0.698-0.960) for suspicious LVEs and 0.72 (95% CI, 0.549-0.891) for probable LVEs. We recommend the use of strict LVE criteria to predict LN metastasis and determine the need for surgical intervention after ESD.
内镜黏膜下剥离术（ESD）被广泛认为是治疗早期胃癌（EGC）的合适方法。ESD 的适应证主要基于 EGC 淋巴结（LN）转移的风险。淋巴管血管内肿瘤细胞栓塞（LVEs）是预测 LN 转移的最重要危险因素，但 LVEs 的诊断标准不一致且存在争议。在这里，我们根据以下标准将 LVE 定义为肿瘤细胞存在于空间内：（1）肿瘤细胞周围有红细胞或淋巴细胞，（2）内皮细胞衬里，（3）附着于血管壁。我们回顾了 102 例接受 ESD 后行胃切除术的 EGC 患者系列，评估了 LVE 的定义，计数了 ESD 标本中的 LVEs 数量，并使用接受者操作特征（ROC）曲线分析验证了 LVE 定义和数量与胃切除标本中 LN 转移存在的相关性。总体而言，在 102 例接受 ESD 后行胃切除术的 EGC 患者中，有 13 例（12.7%）发生 LN 转移。LN 转移阳性组 ESD 标本中明确（4.46±2.45 与 0.19±0.07）、可疑（3.15±0.76 与 0.62±0.14）和可能（1.62±0.43 与 0.43±0.10）的 LVEs 数量均高于 LN 转移阴性组。在 ROC 分析中，明确 LVEs 的 ROC 曲线下面积为 0.851（95%置信区间 [CI]，0.711-0.991），而可疑 LVEs 为 0.82（95% CI，0.698-0.960），可能的 LVEs 为 0.72（95% CI，0.549-0.891）。我们建议使用严格的 LVE 标准来预测 LN 转移，并确定 ESD 后是否需要手术干预。
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