Extensive lymphatic spread of cancer cells in patients with thoracic esophageal squamous cell carcinoma: Detection of CEA-mRNA in the three-field lymph nodes

Background and Objectives The aim of this study is to clarify the extent of lymphatic spread of cancer cells using a novel genetic test to examine patients with thoracic esophageal squamous cell carcinoma (ESCC). Methods A total of 35 patients who underwent an esophagectomy with three‐field lymph node (LN) dissection were eligible. The regional LN stations were categorized into the cervical (C), recurrent nerve (RN), paraesophageal (PE), tracheo‐bronchial (TB), and perigastric (PG) nodes. Lymphatic spread was pathologically diagnosed with Hematoxylin‐Eosin (HE) and anti‐cytokeratin immunohistochemistry (IHC) staining, and CEA‐mRNA expression was examined using the transcription‐reverse transcription concerted (TRC) reaction. Results The rates of lymphatic spread with HE, IHC, and TRC were 7.2%, 10.1%, and 55.5%, respectively. The number of CEA‐mRNA(+) LN stations significantly correlated with tumor depth, LN metastasis diagnosed by HE, and vascular invasions. CEA‐mRNA expression was observed in 42.9%, 94.3%, 77.1%, 80.0%, and 82.9% of C, RN, TB, PE, and PG nodes, respectively. Conclusions The high frequency of CEA‐mRNA expression suggests that systemic therapy is necessary in addition to esophagectomy with adequate LN dissection. Conversely, a relatively low frequency of CEA‐mRNA expression in the C node does not support the routine dissection of the LNs in this area. J. Surg. Oncol. 2010;102:509–515. © 2010 Wiley‐Liss, Inc.