Morphometric analysis of regional lymph nodes with anal without metastasisfrom early gastric carcinoma

BACKGROUND. To the authors' knowledge detailed morphometric changes in lymp h nodes with and without metastasis in patients with early gastric carcinom a remain undocumented. METHODS. Histologic slides of 1847 lymph nodes dissected from 115 consecuti ve patients who underwent gastrectomy for early gastric carcinoma were exam ined histologically and measured using computer morphometry with the public domain National Institutes of Health Image program. Quantitative data were analyzed in relation to preoperative and intraoperative clinical assessmen ts and postoperative pathologic diagnosis. RESULTS. Metastasis was found in 11 lymph nodes (0.6%) from 8 patients (7.0 %). Metastatic lymph nodes showed a mean maximum dimension of 4.8 mm, a mea n area of 14.4 mm(2), and a mean ratio of maximum/minimum dimension of 1.36 ; the corresponding values for nonmetastatic lymph nodes were 4.7 mm (P = 0 .45), 13.2 mm(2) (P = 0.13), and 1.66 (P = 0.10), respectively. The lymph n ode with a metastasis was not necessarily the largest of the dissected lymp h nodes from each patient, and histologically each lymph node with a metast asis showed pericancerous fibrosis in > 10% of its area. The sensitivities of preoperative computed tomography, abdominal ultrasonography (US), endosc opic US, and intraoperative assessments to diagnose metastasis were 0%, 13% , OW, and 13%, respectively, and the sensitivities of these modalities to d etect lymph nodes > 10 mm in dimension were 18%, 10%, 3%, and 10%, respecti vely. CONCLUSIONS. Digital quantitative analysis is useful and widely applicable to clinicopathologic evaluation. The diagnostic sensitivity of lymph node m etastasis in patients with early gastric carcinoma in the current study was very low with preoperative and intraoperative assessments because lymph no de metastases were small and showed subtle histologic changes of pericancer ous (C) 2000 American Cancer Society..