Department of Pathology, University Hospital of Copenhagen, Rigshospitalet, Frederik V's Vej 11, 2100 Copenhagen, Denmark.
Department of Surgical Gastroenterology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Hum Pathol. 2019 Nov;93:90-96. doi: 10.1016/j.humpath.2019.08.015. Epub 2019 Aug 22.
Regional lymph node metastases in patients with carcinoma of the esophagogastric junction (EGJ) are an important prognostic factor. According to the tumor, node, and metastasis classification, isolated tumor cells (ITCs) are single tumor cells or small clusters of tumor cells not exceeding 0.2 mm. Tumor clusters >0.2 mm are classified as metastases. The significance of lymph nodes with ITCs is unclear, although not contributing to the pN category. The aim of this study was to determine the prevalence of regional lymph nodes with ITCs on the primary hematoxylin and eosin-stained slide and to examine how often deeper sections reveal a true metastasis. The study included surgical specimens of 126 patients with adenocarcinoma of the EGJ. Lymph nodes with ITCs were identified. Additional sections were cut and stained with hematoxylin and eosin and with cytokeratin. All slides were evaluated for the presence of tumor cells, and it was determined whether the criteria for a metastasis were met on the additional sections. ITCs were detected in 59 (1.7%) of 3454 lymph nodes and in 41 (32.5%) of 126 patients. In 29 (49.2%) lymph nodes with ITCs on the primary slide, further sections resulted in a changed status from ITCs to a metastasis. In 7 (17.1%) of 41 patients, the pN category was changed. In patients with adenocarcinoma of the EGJ, the presence of ITCs in regional lymph nodes is a common observation. ITCs often represent part of a real metastasis. To obtain a pN category as accurate as possible, we strongly recommend thorough examination of regional lymph nodes with additional sections when ITCs are observed.
食管胃结合部腺癌（EGJ）患者的区域淋巴结转移是一个重要的预后因素。根据肿瘤、淋巴结和转移分类，孤立肿瘤细胞（ITC）是指不超过 0.2mm 的单个肿瘤细胞或小肿瘤细胞簇。肿瘤簇>0.2mm 被归类为转移。虽然淋巴结 ITC 不影响 pN 分期，但淋巴结 ITC 的意义尚不清楚。本研究旨在确定原发性苏木精和伊红染色切片上区域淋巴结 ITC 的发生率，并检查更深入的切片是否经常揭示真正的转移。该研究纳入了 126 例食管胃结合部腺癌患者的手术标本。确定了淋巴结 ITC。进一步切取并分别用苏木精和伊红染色及角蛋白染色。所有切片均评估肿瘤细胞的存在，并确定在额外切片上是否符合转移的标准。在 3454 个淋巴结中的 59 个（1.7%）和 126 例患者中的 41 例（32.5%）中检测到 ITC。在原发性切片中 ITCs 存在的 29 个（49.2%）淋巴结中，进一步的切片导致状态从 ITC 改变为转移。在 41 例患者中的 7 例（17.1%）中，pN 分期发生改变。在食管胃结合部腺癌患者中，区域淋巴结中 ITCs 的存在是一种常见的观察结果。ITC 通常代表真正转移的一部分。为了尽可能获得准确的 pN 分期，当观察到 ITC 时，我们强烈建议对区域淋巴结进行额外切片的彻底检查。
