Preoperative mapping of lymphatic drainage from the tumor using ferumoxide-enhanced magnetic resonance imaging in clinical submucosal thoracic squamous cell esophageal cancer

Background. In thoracic esophageal cancer, lymph node metastases distribute widely from the neck to the abdominal area as a result Of a complex periesophageal lymphatic network. The aim of the present study was to evaluate the potential clinical utility of a new method of mapping lymphatic drainage from tumors using ferumoxide-enhanced magnetic resonance imaging (MRI). Methods. Twenty-three patients with clinical submucosal thoracic squamous cell esophageal cancer were examined. Terumoxides were injected endoscopically into the peritumoral submucosal layer, after which their appearance in the lymph nodes in the neck, superior mediastinum, and abdomen was evaluated using MRI. Results. Flux of ferumoxides from tumors was detected in all 23 patients. Among the 20 patients with middle and lower thoracic esophageal cancers, there was no lymphatic drainage to the neck in 5 (25%) patients, none to the neck and superior mediastinum in 4 (20%), and none to the abdomen in 2 (10%), which could enable the extent of lymph node dissection to be reduced. We diagnosed clinical negative lymph node metastasis (NO) in 17 patients; the remaining 6 patients were diagnosed with clinical lymph node metastasis. Two patients (12%) diagnosed clinical NO, showed pathologic lymph node metastasis. Ferumoxide-enhanced MRI detected an influx of contrast agent into the metastatic node in both patients. Conclusions. Ferumoxide-enhanced MRI lymphatic mapping enables detection of the direction and area of lymphatic flux. It thus has the potential to improve our ability to gauge the appropriate extent of treatment in clinical submucosal squamous cell esophageal cancer.