J Gastric Cancer.  2018 Mar;18(1):20-29. 10.5230/jgc.2018.18.e1.

Is Lymph Node Size a Reliable Factor for Estimating Lymph Node Metastasis in Early Gastric Cancer?

• Kim DJ
• Kim W

• KMID: 2414543
• DOI: http://doi.org/10.5230/jgc.2018.18.e1

Abstract

PURPOSE
Pre-operative lymph node (LN) size is a valuable parameter for determining treatment strategy for gastric cancer. However, a correlation between LN size and metastasis has not been established.
MATERIALS AND METHODS
Thirty-six LN-positive (LNP) and matched 36 LN-negative (LNN) patients were included, and pathology slides of the LNs of these patients were reviewed. All the LNs were measured along the long-axis (LA) and short-axis (SA), manually.
RESULTS
Average retrieved LNs were 37.3±19.8 and 40.5±11.6 in the LNN and LNP groups, respectively. In total 2,800 LNs, including 136 metastatic LNs (MLNs) and 2,664 non-metastatic LNs (nMLNs), were evaluated. Mean length was significantly more in MLNs along both, the LA and SA (MLN_LA vs. nMLN_LA: 4.97±3.84 vs. 3.37±2.40 mm, MLN_SA vs. nMLN_SA: 3.86±3.19 vs. 2.43±1.59 mm; P<0.001). However, 92.6% (126/136) and 95.6% (130/136) of MLNs were <10 mm along the LA and SA, respectively. In addition, only 22.2% of the LNP group exhibited an MLN as the largest LN.
CONCLUSIONS
Pre-operative multi-detector computed tomography has limited ability in estimating the presence of metastasis in LNs because most MLNs are less than 10 mm, and only a small proportion of the LNP group exhibits an MLN as the largest MLN.

Keyword

Stomach neoplasms; Lymph nodes; Diagnosis

MeSH Terms

Diagnosis
Humans
Lymph Nodes*
Neoplasm Metastasis*
Pathology
Stomach Neoplasms*

Figure

• 

  Fig. 1 (A) Representative photograph used for measuring LN size. (B) Comparison of LN size between a fresh specimen and a formalin-embedded specimen shows a minor size discrepancy (fresh vs. formalin-embedded, 11.0 vs. 10.5 mm).LN = lymph node.

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  Fig. 2 Distribution of LN size according to (A) LA of nMLNs, (B) LA of MLNs, (C) SA of nMLNs (D) SA of MLNs.LN = lymph node; LA = long-axis; nMLN = non-metastatic lymph node; MLN = metastatic lymph node; SA = short-axis.

• 

  Fig. 3 Correlation between LA and SA of whole LNs (several circles are overlaid because of similar size).LA = long-axis; SA = short-axis; LN = lymph node; nMLN = non-metastatic lymph node; MLN = metastatic lymph node.

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  Fig. 4 Size difference according to LN stations.LN = lymph node; nMLN = non-metastatic lymph node; MLN = metastatic lymph node; LA = long-axis; SA = short-axis.

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