title: Area of nodal metastasis and radioisotope uptake in sentinel nodes of upper gastrointestinal cancer.
abstract: BACKGROUND
  Sentinel node navigation surgery has been introduced for the treatment of gastrointestinal tumor. As few studies have examined relationships between metastatic area and radioisotope uptake in sentinel nodes, the present study examined this relationship for gastric and esophageal cancers.
  
  
  METHODS
  Subjects comprised 43 patients (esophageal cancer, n = 19; gastric cancer, n = 24) with < or =3 lymph node metastases in whom sentinel node mapping with radio-guided methods was performed. Radioisotope uptake was measured after surgery for all dissected lymph nodes. Metastatic area was calculated using the following formula: metastatic area (%) = (area of metastasis/total area of lymph node) x 100. Based on radioisotope uptake, lymph nodes were divided into RI(-) and RI(+) groups.
  
  
  RESULTS
  In 35 patients, > or =1 metastatic node was present among the sentinel nodes. In 1 patient, no sentinel nodes were detected. No lymph node metastasis was found in sentinel nodes in the remaining seven patients. Lymph nodes were diagnosed as metastatic using preoperative imaging. Mean (+/-SD) metastatic area was significantly higher for RI(-) (68.3 +/- 20.5%) than for RI(+) (15.1 +/- 20.8%; P < 0.0001). Radioisotope uptake was decreased in lymph nodes with >60% metastatic area.
  
  
  CONCLUSIONS
  The fact that radioisotope uptake is not detectable in some lymph nodes with >60% metastatic area must be considered when planning sentinel node navigation surgery.
authors.affiliation: Department of Surgical Oncology and Digestive Surgery, Field of Oncology, Course of Advanced Therapeutics, Kagoshima University School of Medical and Dental Science, Kagoshima, Japan. h-arima@m3.kufm.kagoshima-u.ac.jp
authors.forename: Hideo
authors.initials: H
authors.lastname: Arima
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Uenosono
authors.forename: Takaaki
authors.initials: T
authors.lastname: Arigami
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Ehi
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Yanagita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Higashi
authors.forename: Sumiya
authors.initials: S
authors.lastname: Ishigami
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hokita
authors.forename: Takashi
authors.initials: T
authors.lastname: Aikou
mesh_terms: D000368:Aged; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007564:Japan; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012044:Regression Analysis; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D018709:Statistics, Nonparametric; D013667:Technetium
chemical_list: D019275:Radiopharmaceuticals; D013667:Technetium