Review of extranodal extension grading for esophageal cancer: three-dimensional radiologic, surgical and pathologic findings

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Abstract: The importance of extranodal extension (ENE) of metastatic lymph nodes (LN) on the prognosis of esophageal cancer, as observed with head and neck squamous cell carcinoma, is emerging. Despite the significance of LN metastasis as a major prognostic factor in esophageal cancer, preoperative clinical ENE LN diagnosis and final pathological evaluation are not routinely diagnosed. Metastatic LN with ENE should be diagnosed because clinical ENE diagnosis predicts not only prognosis, but also difficulty of the operative procedure during LN dissection. We provide an atlas of correlations between three-dimensional computed tomography (CT) imaging findings and pathological findings with the information of surgical findings. An irregular border of LN to adjacent planes or other organs, indicating a disrupted capsule, is the most important histological information in the diagnosis of ENE. In consistency between radiographic findings and pathological findings, CT imaging was not associated with pathological ENE findings because of limitations from the constructed axial view. The pathological view of LN is made by cutting at the maximum diameter. The pathological findings did not necessarily match conventional CT findings because of different analysis views. The surgical findings did also not match conventional CT findings. Accurate clinical diagnosis of ENE is important to plan the appropriate multimodality treatment.

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