PREOPERATIVE ASSESSMENT OF LYMPH-NODES IN THE PREDICTION OF DISEASE SPREAD AND OUTCOME IN CANCER OF THE THORACIC ESOPHAGUS

Prospective assessment of lymph node status, based on the findings of computed tomography, external ultrasonography and palpation, was compared with clinical results in 179 patients who underwent oesophagectomy with systematic node dissection. Preoperative findings for each node group were classified into four grades: involvement not suspected (-); possible involvement (+/-); probable involvement (+); and definite involvement (++). When only (++) or (+) assessment was categorized as positive, the specificity was more than 94 per cent, although the sensitivity was less than 40 per cent. The preoperative assessment correlated significantly with the incidence of node involvement (P < 0.02), the degree of lymphatic invasion (P < 0.0001) and outcome after operation. For patients with all nodes assessed as (-), the 5-year survival rate was 70 per cent, compared with 26 per cent for those with nodes assessed as (++), P = 0.001. Preoperative assessment provided useful information on nodal status.