Preoperative clinical diagnosis of lymph node (LN) metastasis and subsequent pathological diagnosis are often not in agreement. Detection of false-negative LNs is essential in selecting an optimal treatment strategy, and most importantly, the presence of false-negative LN is itself a significant prognostic indicator. Therefore, at present, there is an urgent need to establish more accurate and individualized evaluation methods for LN metastasis. Of 213 cN0 patients who underwent curative esophagectomy without preoperative neoadjuvant treatment, 60 (28%) had LN metastasis diagnosed pathologically. There were 129 false-negative LNs, of which 85 were detectable by preoperative computed tomography (CT). We retrospectively investigated the distribution, frequency, and characteristics of pathologically positive nodes in patients with clinically N0 esophageal cancer. The paracardial region was the most frequent region of false-negative LNs, accounting for 26% (22 LNs) of the total incidence. False-negative LNs distributed widely from the neck to the abdomen in patients with a primary tumor in the middle thoracic esophagus. In patients with a primary tumor in the lower thoracic esophagus, four false-negative LNs were detected in the superior mediastinum. When the short-axis diameter, shape, and attenuation patterns of the LNs were used as criteria for metastasis diagnosis, they were insufficient for an accurate diagnosis. However, false-negative LNs in the most frequently occurring sites are characterized by smaller short-axis, suggesting that accurate diagnosis cannot be made unless the diagnostic criteria for the short-axis are reduced in addition to shape and attenuation. Although restrictive to the most frequent regions of false-negative LNs occur, reducing size criterion and consideration of their shape and attenuation may contribute to improved diagnosis.

中文翻译：

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cN0胸段食管癌患者淋巴结转移与病理淋巴结诊断不一致的评估。

术前对淋巴结（LN）转移的临床诊断与随后的病理学诊断通常不一致。假阴性LN的检测对于选择最佳治疗策略至关重要，最重要的是，假阴性LN的存在本身就是重要的预后指标。因此，目前迫切需要建立更准确和个性化的LN转移评估方法。在213例未经手术前接受新辅助治疗的食管癌根治术中，有60例（28％）经病理诊断为LN转移。有129个假阴性LN，其中术前CT可以检测到85个。我们回顾性地调查了分布，频率，N0食管癌患者的病理阳性淋巴结的特征和特征。心包旁区域是假阴性LN的最常见区域，占总发生率的26％（22 LN）。假阴性的LNs在患有中胸段食道的原发性肿瘤患者中从颈部到腹部广泛分布。在胸下食管原发性肿瘤的患者中，在纵隔上段检测到四个假阴性的LN。当将LN的短轴直径，形状和衰减模式用作转移诊断的标准时，它们不足以进行准确的诊断。但是，在最频繁发生的位置中，假阴性LN的特征在于较短的短轴，这表明除非进行形状和衰减的减少，否则除非对短轴的诊断标准有所降低，否则无法做出准确的诊断。尽管限制假阴性LN的最常见区域出现，但减小大小标准以及考虑其形状和衰减可能有助于改善诊断。