Sentinel node biopsy using dye and isotope double tracers in early gastric cancer.
BACKGROUND
The results of sentinel node (SN) biopsy have been improved by the use of dye and isotope double tracers in melanoma and breast cancer. However, the usefulness of this double tracer technique has not been determined in gastric cancer. The aim of this study was to investigate the possibility of improving SN biopsy results by using double tracers in gastric cancer.


METHODS
Sixty-four gastric adenocarcinoma patients preoperatively diagnosed as cT1N0, were enrolled in the study. (99m)Tc tin colloid was injected by preoperative endoscopy, and lymphoscintigraphy was performed prior to operation. After laparotomy, isosulfan blue was intraoperatively injected using an endoscope. Blue-stained or radioactive nodes were identified and defined as SNs. Gastrectomy with D2 lymphadenectomy was performed in all patients. All dissected lymph nodes were evaluated for metastasis by hematoxylin and eosin staining and immunohistochemistry.


RESULTS
SN detection rates using dye, isotope, or both tracers were 95.3%, 84.4%, and 96.9%, respectively, and their corresponding sensitivities were 52.9%, 52.9%, and 70.6%. In the pT1 subset, the sensitivity of the double tracer was 87.5%; and in a subset of tumors with diameter <4.5 cm, this was also 87.5%.


CONCLUSIONS
These findings confirm that SN biopsy results are improved by using double tracers in gastric cancer and suggest that SN biopsy is suitable in cases of small-sized early gastric cancer.
Lee
Jun Ho
JH
Research Institute and Hospital, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, South Korea.
Ryu
Keun Won
KW
Kim
Chan Gyoo
CG
Kim
Seok-Ki
SK
Lee
Jong-Seok
JS
Kook
Myeong-Cherl
MC
Choi
Il Ju
IJ
Kim
Young Woo
YW
Chang
Hee Jin
HJ
Bae
Jae-Moon
JM
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D017556:Technetium Compounds; D017971:Tin Compounds
D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D017556:Technetium Compounds; D017971:Tin Compounds; C033493:technetium Tc 99m tin colloid; C025484:iso-sulfan blue