Lymph node (LN) metastasis is negligible in early gastric cancer (EGC) within expanded criteria for endoscopic submucosal dissection (ESD). However, regional lymph nodes in abdominal CT scans are sometimes enlarged in patients with EGC within the expanded criteria for endoscopic submucosal dissection (ESD). In this study, we investigated the clinical significance of regional lymph node enlargement on abdominal CT scan in patients with EGC within the expanded criteria for ESD. From December 2010 to April 2015, among 301 patients with EGC within the ESD expanded criteria, 47 patients with regional lymph node enlargement shown by abdominal CT scan were prospectively enrolled. We performed surgical resection or periodic follow-up with abdominal CT scans and upper endoscopy every 6 months to evaluate whether the enlarged lymph nodes are due to metastasis or a reactive change. The mean age of the 47 patients (38 males, 9 female) was 64.8 years. The enlarged lymph nodes were usually single (26/47, 44.6%) and sized as follows: 11 nodes were ≤ 5 mm, 19 were 6–10 mm, and 17 were ≥ 10 mm. Four of the 47 patients initially underwent surgical resection, and 8 patients underwent surgical resection after ESD. However, there was no lymph node metastasis in surgical specimens. Thirty-five patients received ESD and periodically followed up at a median duration of 56 months (IQR: 44–59 month). The enlarged lymph node disappeared in 12 of 35 patients, decreased in 9 patients and remained the same size in 13 patients, and increased in 1 patient. Regional lymph node enlargement on abdominal CT scan in patients within expanded criteria for ESD of ECG may be not due to metastasis but a reactive change.

中文翻译：

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ESD 扩展标准内 EGC 患者区域淋巴结肿大的临床意义


根据内镜粘膜下剥离术 (ESD) 的扩展标准，早期胃癌 (EGC) 的淋巴结 (LN) 转移可以忽略不计。然而，在内镜粘膜下剥离术（ESD）的扩展标准范围内，EGC 患者的腹部 CT 扫描中的区域淋巴结有时会增大。在本研究中，我们研究了 ESD 扩展标准内 EGC 患者腹部 CT 扫描局部淋巴结肿大的临床意义。 2010年12月至2015年4月，在301例符合ESD扩展标准的EGC患者中，前瞻性入组了47例腹部CT扫描显示区域淋巴结肿大的患者。我们每 6 个月进行一次手术切除或定期随访腹部 CT 扫描和上消化道内窥镜检查，以评估肿大的淋巴结是否是由于转移或反应性变化所致。 47 名患者（38 名男性，9 名女性）的平均年龄为 64.8 岁。肿大的淋巴结通常为单个（26/47，44.6%），大小如下：11个淋巴结≤5mm，19个淋巴结为6-10mm，17个淋巴结≥10mm。 47 例患者中，4 例最初接受了手术切除，8 例患者在 ESD 后接受了手术切除。但手术标本未见淋巴结转移。 35 名患者接受了 ESD 治疗并定期随访，中位随访时间为 56 个月（IQR：44-59 个月）。 35 名患者中，12 名肿大淋巴结消失，9 名患者缩小，13 名患者大小不变，1 名患者增大。在心电图 ESD 扩展标准范围内的患者中，腹部 CT 扫描显示区域淋巴结肿大可能不是由于转移，而是由于反应性变化。