Detection and clinical significance of lymph node micrometastasis determined by reverse transcription-polymerase chain reaction in patients with esophageal carcinoma

We investigated micrometastasis in lymph nodes by detecting carcinoembryoni c antigen (CEA) mRNA. A total of 400 lymph nodes obtained from 21 patients with esophageal carcinoma were examined by CEA-specific reverse transcripti on-polymerase chain reaction (RT-PCR), Serial sections of positive lymph no des were reexamined histologically and immunohistologically. Twenty-seven l ymph nodes of 11 patients were diagnosed as being positive by conventional histologic examination. CEA-mRNA positivity was found in 18 of 21 patients. Among 373 histologically negative nodes, 79 (21.2%) were positive for CEA mRNA. Of these, micrometastasis was detected in 2 by histological reexamina tion and in 11 by immunohistochemical staining using cytokeratin antibody. Two of 6 RT-PCR-positive patients (33.3%) had recurrent disease. Four of 11 patients (36.4%) whose nodal involvement was discovered by routine histolo gical examination also had recurrent cancer. CEA-specific RT-PCR detected m icrometastasis in lymph nodes at a higher rate than histological or immunoh istochemical analysis of serial sections. Since the incidence of CEA-mRNA p ositivity is high in the Lymph nodes of esophageal cancer patients except f or those with early cancer, these patients should be treated with adjuvant therapy. Copyright (C) 2000 S. Karger AG. Basel.