Evolution of the treatment of esophageal cancer: artificial intelligence and the role of sentinel lymph node assessment in esophageal cancer

Abstract

Sentinel lymph node (SLN) biopsy has revolutionized the staging and prognosis of breast cancer and melanoma. Because of the complicated lymphatic network around the esophagus, the utility of SLN biopsy for esophageal cancer is less clear. The accuracy of SLN mapping in esophageal cancer depends on tumor site, disease stage, use of neoadjuvant therapy, and patient characteristics. SLN biopsy may improve staging and result in less morbidity in patients with early esophageal cancer, compared with radical lymphadenectomy and esophagectomy. A recent study that investigated hybrid tracers in sentinel node navigation surgery (SNNS) demonstrated promising results for the detection of peritumoral SLNs. However, evidence that firmly establishes the concept of the SLN for esophageal cancer is still lacking. Big data analytics and artificial intelligence have been associated with improvements in the detection and prognosis of esophageal cancer. This review considers the roles of the evolving technologies of SLN biopsy and artificial intelligence, which together have the potential to further improve prognoses and outcomes for patients with esophageal cancer. Additional investigation is necessary to establish standardized protocols and to determine the long-term effectiveness of these approaches in settings involving neoadjuvant therapy and advanced-stage disease.

Keywords

Sentinel node navigation surgery / esophageal cancer / T1b stage / sentinel lymph node biopsy

References

[1] Morrow M,Patil S.Axillary dissection and nodal irradiation can be avoided for most node-positive Z0011-eligible breast cancers: a prospective validation study of 793 patients.Ann Surg2017;266:457-62 PMCID:PMC5649371

[2] Giuliano AE.The evolution of sentinel node biopsy for breast cancer: personal experience.Breast J2020;26:17-21

[3] Morton DL, Thompson JF, Cochran AJ, et al; MSLT Group. Final trial report of sentinel-node biopsy versus nodal observation in melanoma.N Engl J Med2014;370:599-609 PMCID:PMC4058881

[4] Veronesi U,Viale G.Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study.Lancet Oncol2006;7:983-90

[5] Krag DN,Julian TB.Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial.Lancet Oncol2010;11:927-33 PMCID:PMC3041644

[6] Lyman GH, Giuliano AE, Somerfield MR, et al; American Society of Clinical Oncology. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.J Clin Oncol2005;23:7703-20

[7] Caldonazzi N,Eccher A.Value of artificial intelligence in evaluating lymph node metastases.Cancers2023;15:2491 PMCID:PMC10177013

[8] Peek G.The future implementation of artificial intelligence technology in esophageal surgery.Art Int Surg2023;3:249-54

[9] Kitagawa Y,Oyama T.Esophageal Cancer Practice Guidelines 2017 edited by the Japan Esophageal Society: part 1.Esophagus2019;16:1-24 PMCID:PMC6510883

[10] Kato H,Nakajima M.Sentinel lymph nodes with technetium-99m colloidal rhenium sulfide in patients with esophageal carcinoma.Cancer2003;98:932-9

[11] Yasuda S,Chino O.Sentinel lymph node detection with Tc-99m tin colloids in patients with esophagogastric cancer.Jpn J Clin Oncol2003;33:68-72

[12] Prenzel KL,Schröder W.Prognostic relevance of skip metastases in esophageal cancer.Ann Thorac Surg2010;90:1662-7

[13] Hagens ERC,Gisbertz SS.Distribution of lymph node metastases in esophageal carcinoma patients undergoing upfront surgery: a systematic review.Cancers2020;12:1592 PMCID:PMC7352338

[14] Nagaraja V,Cox MR.Sentinel lymph node in oesophageal cancer-a systematic review and meta-analysis.J Gastrointest Oncol2014;5:127-41 PMCID:PMC3999634

[15] Kitagawa Y,Mukai M.The role of the sentinel lymph node in gastrointestinal cancer.Surg Clin North Am2000;80:1799-809

[16] Sung H,Siegel RL.Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin2021;71:209-49

[17] Manner H,May A.Early-stage adenocarcinoma of the esophagus with mid to deep submucosal invasion (pT1b sm2-3): the frequency of lymph-node metastasis depends on macroscopic and histological risk patterns.Dis Esophagus2017;30:1-11

[18] Gockel I,Lyros O.Risk of lymph node metastasis in submucosal esophageal cancer: a review of surgically resected patients.Expert Rev Gastroenterol Hepatol2011;5:371-84

[19] Newton AD,Xia L.Surgical management of early-stage esophageal adenocarcinoma based on lymph node metastasis risk.Ann Surg Oncol2018;25:318-25

[20] Yang Y,Qin J.Mapping of lymph node metastasis from thoracic esophageal cancer: a retrospective study.Ann Surg Oncol2022;29:5681-8

[21] Hosch SB,Pichlmeier U.Esophageal cancer: the mode of lymphatic tumor cell spread and its prognostic significance.J Clin Oncol2001;19:1970-5

[22] Feith M,Siewert JR.Pattern of lymphatic spread of Barrett’s cancer.World J Surg2003;27:1052-7

[23] Guidozzi N,Chidambaram S.The role of artificial intelligence in the endoscopic diagnosis of esophageal cancer: a systematic review and meta-analysis.Dis Esophagus2023;36:doad048 PMCID:PMC10789250

[24] Gómez B, Milla Collado L, Rodríguez M. Artificial intelligence in esophageal cancer diagnosis and treatment: where are we now? - a narrative review.Ann Transl Med2023;11:353 PMCID:PMC10477654

[25] Cykowska A,D’Ignazio A.New technologies in breast cancer sentinel lymph node biopsy; from the current gold standard to artificial intelligence.Surg Oncol2020;34:324-35

[26] Liu Y,Norouzi M.Artificial intelligence-based breast cancer nodal metastasis detection: insights into the black box for pathologists.Arch Pathol Lab Med2019;143:859-68

[27] Oliver JR,Fassas SN,Bur AM.Machine learning directed sentinel lymph node biopsy in cutaneous head and neck melanoma.Head Neck2022;44:975-88

[28] Kan T,Sato F.Prediction of lymph node metastasis with use of artificial neural networks based on gene expression profiles in esophageal squamous cell carcinoma.Ann Surg Oncol2004;11:1070-8

[29] Zhang YH,Yuan XL.Artificial intelligence-assisted esophageal cancer management: now and future.World J Gastroenterol2020;26:5256-71 PMCID:PMC7504247

[30] Obermannová R, Alsina M, Cervantes A, et al; ESMO Guidelines Committee. Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.Ann Oncol2022;33:992-1004

[31] Ajani JA,Bentrem DJ.Esophageal and esophagogastric junction cancers, version 2.2023, NCCN clinical practice guidelines in oncology.J Natl Compr Canc Netw2023;21:393-422

[32] van der Werf LR, Busweiler LAD, van Sandick JW, van Berge Henegouwen MI, Wijnhoven BPL; Dutch Upper GI Cancer Audit (DUCA) group. Reporting national outcomes after esophagectomy and gastrectomy according to the Esophageal Complications Consensus Group (ECCG).Ann Surg2020;271:1095-101

[33] Dunbar KB.The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett’s esophagus: a systematic review.Am J Gastroenterol2012;107:850-62 PMCID:PMC3578695

[34] Nieuwenhuis EA, van Munster SN, Meijer SL, et al; Dutch Barrett Expert Centers. Analysis of metastases rates during follow-up after endoscopic resection of early “high-risk” esophageal adenocarcinoma.Gastrointest Endosc2022;96:237-47.e3

[35] Kamarajah SK,Hanna GB,Markar SR.Is local endoscopic resection a viable therapeutic option for early clinical stage T1a and T1b esophageal adenocarcinoma? A propensity-matched analysis.Ann Surg2022;275:700-5

[36] Altorki NK,Liss Y.Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma: implications for endoscopic treatment.Ann Surg2008;247:434-9

[37] Künzli HT,Pouw RE.Endoscopic management and follow-up of patients with a submucosal esophageal adenocarcinoma.United European Gastroenterol J2018;6:669-77 PMCID:PMC6068782

[38] Schölvinck D,Meijer S.Management of patients with T1b esophageal adenocarcinoma: a retrospective cohort study on patient management and risk of metastatic disease.Surg Endosc2016;30:4102-13

[39] Takeuchi H.Sentinel node navigation surgery in esophageal cancer.Ann Gastroenterol Surg2019;3:7-13 PMCID:PMC6345658

[40] Overwater A,Ruurda JP.Feasibility of sentinel node navigated surgery in high-risk T1b esophageal adenocarcinoma patients using a hybrid tracer of technetium-99 m and indocyanine green.Surg Endosc2022;36:2671-9 PMCID:PMC8921120

[41] Künzli HT,Gisbertz SS.Pilot-study on the feasibility of sentinel node navigation surgery in combination with thoracolaparoscopic lymphadenectomy without esophagectomy in early esophageal adenocarcinoma patients.Dis Esophagus2017;30:1-8

[42] Frederiks CN,Bergman JJGHM.Feasibility and safety of tailored lymphadenectomy using sentinel node-navigated surgery in patients with high-risk T1 esophageal adenocarcinoma.Ann Surg Oncol2023;30:4002-11 PMCID:PMC10035969

[43] Uenosono Y,Yanagita S.Sentinel node navigation surgery is acceptable for clinical T1 and N0 esophageal cancer.Ann Surg Oncol2011;18:2003-9

[44] Thompson SK.Sentinel node biopsy in high-risk pT1 esophageal cancer: a long-awaited study.Ann Surg Oncol2023;30:3889-91