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DOI: 10.1055/s-2005-920327
Sentinel Lymph Node Detection in Gastric Cancer – A Single Institution Study
Introduction: We prospectively evaluated the feasibility and sensitivity of sentinel node identification in a series of 45 consecutive patients who underwent primary resection for gastric cancer in a single Western center.
Patients and Methods: 45 patients (age: 28–82 years) with T1– T3, N0,N+ gastric cancer (based on preoperative endoscopic ultrasound) were included into the study. 2ml 60mBq TC99m-nanocolloid was injected submucosally around the tumor 16–18h prior to surgery. After laparotomy the activity of all lymph node stations according to the Japanese Gastric Cancer Association was measured with the help of a hand-held gamma probe. Additional blue dye injection was performed by intraoperative endoscopy in most of the cases. All sentinel nodes were removed from the resected specimen and asservated for histopathologic assessment including serial sections and immunohistochemistry.
Results: 12 patients had a cancer of the proximal third, 10 patients of the middle third, 22 patients of the distal third and one patient with a total carcinoma. In 40 out of 45 (88%) patients one or more sentinel lymph node could be identified. Identification rate for T1 tumors was 92% (23/25), for T2/3 tumors 85% (17/20). The median range was 1–6 lymph nodes. A correct prediction of the nodal status was possible in 36 out of 40 patients (90%). Combined blue dye and radiocolloid increased the prediction rate to 91%. The prediction rate for T1 tumors was 91% (21/23), for T2 /T3 tumors was 88% (15/17).In 28 patients nodal negative the overall prediction rate of the lymph node status was 92% (26/28). In 17 nodal positive patients the overall prediction rate was 58% (10/17). Immunohistochemistry showed upstaging in two patients with a negative sentinel node.
Conclusion: Sentinel node identification in gastric cancer is feasible. The correct prediction rate dropped significantly in case of manifest lymph node metastases, especially if lymphangiosis was present. This was true even in T1 tumors. Sentinel lymph node identification, which may lead to an individual indication for lymphadenectomy, might be applicable with sufficient sentivity only in patients with early gastric cancer.
Keywords: Gastric cancer, sentinel lymph node, staging