Radio-guided sentinel node detection for gastric cancer.
BACKGROUND
Radio-guided detection of sentinel nodes (SNs) has been used to predict regional metastases in patients with malignant melanoma and breast cancer. However, the validity of the SN hypothesis is still controversial for gastrointestinal cancers including gastric cancer. The aim of this study was to test the feasibility and accuracy of radio-guided mapping of SNs for gastric cancer.


METHODS
Some 145 consecutive patients with gastric cancer diagnosed as T1 or T2 and evaluated clinically as N0 were enrolled. Endoscopic injection of technetium-99m-radiolabelled tin colloid was performed before operation and radioactive SNs were identified with a gamma probe. Standard radical gastrectomy with lymphadenectomy was performed in all patients and all resected nodes were evaluated by routine histopathological examination.


RESULTS
Using radio-guided methods, SNs were detected in 138 (95.2 per cent) of 145 patients. The SN was positive in 22 of 24 patients with lymph node metastasis. The incidence of metastasis in the SNs (7.8 per cent) was significantly higher than that in the non-SNs (0.3 per cent) (P < 0.01). The diagnostic accuracy according to SN status was 98.6 per cent (136 of 138).


CONCLUSIONS
Radio-guided SN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with early-stage gastric cancer.
Kitagawa
Y
Y
Departments of Surgery, Radiology and Pathology, Keio University, Tokyo, Japan. kitagawa@sc.itc.keio.ac.jp
Fujii
H
H
Mukai
M
M
Kubota
T
T
Otani
Y
Y
Kitajima
M
M
D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000592:standards; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*; D017556:Technetium Compounds; D017971:Tin Compounds
D019275:Radiopharmaceuticals; D017556:Technetium Compounds; D017971:Tin Compounds; C033493:technetium Tc 99m tin colloid