Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Dec;3(6):505-13.
doi: 10.1177/2050640615581965.

Submucosal invasion and risk of lymph node invasion in early Barrett's cancer: potential impact of different classification systems on patient management

Dimitrios Fotis  1 , Michael Doukas  2 , Bas Pl Wijnhoven  3 , Paul Didden  1 , Katharina Biermann  2 , Marco J Bruno  1 , Arjun D Koch  1
Affiliations

Submucosal invasion and risk of lymph node invasion in early Barrett's cancer: potential impact of different classification systems on patient management

Dimitrios Fotis et al. United European Gastroenterol J. 2015 Dec.

Abstract

Background: Due to the high mortality and morbidity rates of esophagectomy, endoscopic mucosal resection (EMR) is increasingly used for the curative treatment of early low risk Barrett's adenocarcinoma.

Objective: This retrospective cohort study aimed to assess the prevalence of lymph node metastases (LNM) in submucosal (T1b) esophageal adenocarcinomas (EAC) in relation to the absolute depth of submucosal tumor invasion and demonstrate the efficacy of EMR for low risk (well and moderately differentiated without lymphovascular invasion) EAC with sm1 invasion (submucosal invasion ≤500 µm) according to the Paris classification.

Methods: The pathology reports of patients undergoing endoscopic resection and surgery from January 1994 until December 2013 at one center were reviewed and 54 patients with submucosal invasion were included. LNM were evaluated in surgical specimens and by follow up examinations in case of EMR.

Results: No LNM were observed in 10 patients with sm1 adenocarcinomas that underwent endoscopic resection. Three of them underwent supplementary endoscopic eradication therapy with a median follow up of 27 months for patients with sm1 tumors. In the surgical series two patients (29%) with sm1 invasion according to the pragmatic classification (subdivision of the submucosa into three equal thirds), staged as sm2-3 in the Paris classification, had LNM. The rate of LNM for surgical patients with low risk sm1 tumors was 10% according to the pragmatic classification and 0% according to Paris classification.

Conclusion: Different classifications of the tumor invasion depth lead to different LNM risks and treatment strategies for sm1 adenocarcinomas. Patients with low risk sm1 adenocarcinomas appear to be suitable candidates for EMR.

Keywords: Early Barrett’s cancer; Paris classification; endoscopic mucosal resection; lymph node metastases; sm1 esophageal adenocarcinoma; submucosal invasion.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart of patients with T1b tumors that underwent review of their medical records and pathological review of their EMR and surgical specimens. EAC, esophageal adenocarcinoma; T1b, submucosal tumors; T1a, intramucosal tumors; sm, submucosal invasion.
See this image and copyright information in PMC

References

    1. Portale G, Hagen JA, Peters JF, et al. Modern 5-year survival of resectable esophageal adenocarcinoma: single institution experience with 263 patients. J Am Coll Surg 2006; 202: 588–596. - PubMed
    1. Seely AJ, Ivanovic J, Threader J, et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg 2010; 90: 936–942. - PubMed
    1. Stein HJ, Feith M, Bjorn LD, et al. Early esophageal cancer pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg 2005; 242: 566–575. - PMC - PubMed
    1. Liu L, Hofstetter WL, Rashid A, et al. Significance of the depth of tumor invasion and lymph node metastasis in superficially invasive (T1) esophageal adenocarcinoma. Am J Surg Pathol 2005; 29: 1079–1085. - PubMed
    1. Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58(6 Suppl): S3–S43. - PubMed