title: Significance of metastasis detected by molecular techniques in sentinel nodes of patients with gastrointestinal cancer.
abstract: The clinical significance of micrometastasis in sentinel nodes (SNs) may differ in various organs. In particular, the prognostic value of SN micrometastases detected by reverse transcriptase-polymerase chain reaction (RT-PCR) is still controversial. We investigated the diagnostic and therapeutic significance of nodal molecular metastasis detected by nested RT-PCR for cytokeratin (CK) 19 mRNA in gastrointestinal cancer. In 51 cases with GI tract cancer treated by standard curative resection, SNs were identified by a radio-guided method. In 10 of 51 patients, 25 SNs and 3 non-SNs were histologically negative and RT-PCR positive. Three non-SNs with positive CK19 mRNA were randomly sampled from the same basin where histologically positive SNs were identified. Immunohistochemical analysis of six additional step sections obtained at 30- micro m intervals with use of an anticytokeratin antibody showed clearly recognizable histological metastases in 4 of 25 histologically negative/RT-PCR-positive SNs (16%). In one case of esophageal squamous cell carcinoma with nodal micrometastasis identified by CK19 RT-PCR, extranodal local recurrence in the SN basin (left supraclavicular basin) was observed 6 months postoperatively. These findings suggest that nodal micrometastasis detected by nested RT-PCR has some clinical significance in GI cancer. Molecular assessment of the SN may be a valuable tool to complement routine histological examination for GI cancers.
authors.affiliation: Department of Surgery, School of Medicine, Keio University, Tokyo, Japan. kitagawa@sc.itc.keio.ac.jp
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Matsuda
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Fujii
authors.forename: Makio
authors.initials: M
authors.lastname: Mukai
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Dan
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kubota
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
authors.forename: Soji
authors.initials: S
authors.lastname: Ozawa
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Otani
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumai
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kubo
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D004938:Esophageal Neoplasms / Q000473:pathology*; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy
chemical_list: D007633:Keratins