title: Sentinel lymph nodes with technetium-99m colloidal rhenium sulfide in patients with esophageal carcinoma.
abstract: BACKGROUND
  The authors assessed the detection of sentinel lymph nodes in patients with esophageal squamous cell carcinoma (SCC) using technetium-99m colloidal rhenium sulfide. They studied whether an analysis of sentinel lymph nodes using cytokeratin (CK) immunohistochemistry increased the accuracy of staging.
  
  
  METHODS
  The authors observed 25 patients with thoracic esophageal carcinomas who underwent radical esophagectomy. The day before surgery, technetium-99m colloidal rhenium sulfide was injected into the submucosa at four sites around the primary tumor. Lymphoscintigraphy was performed. Esophagectomy and regional lymph node dissection were performed 17 hours after the technetium-99m injection. After surgery, the resected lymph nodes were evaluated by CK staining.
  
  
  RESULTS
  Lymphoscintigraphy detected sentinel lymph nodes in 92% of the patients (23 of 25 patients). The accuracy of sentinel lymph node was 91.3% (21 of 23 patients), the sensitivity was 86.7% (13 of 15 patients), and the false-negative rate was 8.7% (2 of 23 patients). A comparison of the number of sentinel lymph nodes and clinicopathologic factors showed that there was a significant association between the number of sentinel lymph nodes and lymph node status (P < 0.01), pathologic stage (P < 0.05), and the number of metastatic lymph nodes (P < 0.05). Occult metastasis was detected by CK staining in 14 (56%) of the 25 patients and in 23 (1.7%) of 1406 lymph nodes. Because the 2 false-negative (sentinel lymph node-negative and nonsentinel lymph node-positive) patients who had occult metastases in the sentinel lymph nodes, the accuracy of sentinel lymph node evaluation using CK staining was 100% (23 of 23).
  
  
  CONCLUSIONS
  Lymphatic mapping with technetium-99m colloidal rhenium sulfide was used to identify the lymphatic basin and was feasible in patients with esophageal SCC. An analysis of sentinel lymph nodes using CK immunohistochemistry increased the accuracy of sentinel lymph node.
authors.affiliation: Department of Surgery I, Gunma University Faculty of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. hiroyuki@po.wind.ne.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Masanobu
authors.initials: M
authors.lastname: Nakajima
authors.forename: Junko
authors.initials: J
authors.lastname: Takita
authors.forename: Makoto
authors.initials: M
authors.lastname: Sohda
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Fukai
authors.forename: Norihiro
authors.initials: N
authors.lastname: Masuda
authors.forename: Minoru
authors.initials: M
authors.lastname: Fukuchi
authors.forename: Ryokuhei
authors.initials: R
authors.lastname: Manda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ojima
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Tsukada
authors.forename: Takayuki
authors.initials: T
authors.lastname: Asao
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
authors.forename: Noboru
authors.initials: N
authors.lastname: Oriuchi
authors.forename: Keigo
authors.initials: K
authors.lastname: Endo
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007120:Immunochemistry; D007633:Keratins / Q000032:analysis; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012211:Rhenium; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D017556:Technetium Compounds
chemical_list: D019275:Radiopharmaceuticals; D017556:Technetium Compounds; C030576:technetium Tc 99m rhenium colloid; D007633:Keratins; D012211:Rhenium