Scoring System of Lee et al for Predicting Lymph Node Metastases in a Patient with a T1 Esophageal Adenocarcinoma

Description

Lee et al reported a scoring system for predicting the risk of lymph node metastases in a patient with an early stage esophageal adenocarcinoma. This can help to identify a patient who may benefit from more aggressive management. The authors are from McGill University, University Medical Center Mannheim, M.D. Anderson Cancer Center, University Health Network Toronto and the Ottawa Hospital.

Patient selection: T1 esophageal adenocarcinoma

Parameters:

(1) diameter in cm

(2) depth (T1a vs T1b)

(3) differentiation

(4) lymphovascular invasion

Parameter	Finding	Points
diameter in cm		<cm>
depth	T1a (lamina propria or muscularis mucosae but not submucosa)	0
	T1b (into submucosa but not muscularis propria)	2
differentiation	well-differentiated	0
	moderately differentiated	3
	poorly differentiated	3
lymphovascular invasion	absent	0
	present	6

where:

• Scoring for diameter is "1 point per cm". In the paper the diameter appears to be rounded to a whole number. In practice the diameter can be in fractions of a centimeter.

• The differentiation could be simplified to whether well-differentiated or not.

total score =

= SUM(points for all 4 parameters)

Interpretation:

• minimum score: < 1 (dependant on tumor diameter)

• maximum score: > 12 (dependent on tumor diameter)

• The higher the score the greater the risk of lymph node metastases.

Total Score	Risk of LN Metastases
< 2	low risk (<= 2%)
2 to 4.9	moderate risk (3-6%)
>= 5	high risk (>= 7%)

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Description

Specialty

ICD-10