Validation study of radio-guided sentinel lymph node navigation in esophageal cancer.
BACKGROUND
Radio-guided detection of sentinel lymph nodes (SLN) has been used to predict regional lymph node metastasis in patients with melanoma and breast cancer. However, the validity of the SLN hypothesis is still controversial for esophageal cancer. The aim of this study is to evaluate the feasibility and accuracy of radio-guided SLN mapping for esophageal cancer.


METHODS
Seventy-five consecutive patients who were diagnosed preoperatively with T1N0M0 or T2N0M0 primary esophageal cancer were enrolled. Endoscopic injection of technetium-99m tin colloid was performed before surgery and radioactive SLNs were identified with preoperative lymphoscintigraphy and gamma probe. Standard radical esophagectomy with lymphadenectomy was performed in all patients and all resected nodes were evaluated by routine pathologic examination.


RESULTS
SLNs were identified successfully in 71 (95%) of 75 patients. The mean number of identified SLNs per case was 4.7. Twenty-nine (88%) of 33 cases with lymph node metastasis showed positive SLNs. The diagnostic accuracy based on SLN status was 94% (67/71). Distribution of identified SLNs was widely spread from the cervical to abdominal areas.


CONCLUSIONS
This study reveals that radio-guided SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with early-stage esophageal cancer.
Takeuchi
Hiroya
H
Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan. htakeuch@sc.itc.keio.ac.jp
Fujii
Hirofumi
H
Ando
Nobutoshi
N
Ozawa
Soji
S
Saikawa
Yoshiro
Y
Suda
Koichi
K
Oyama
Takashi
T
Mukai
Makio
M
Nakahara
Tadaki
T
Kubo
Atsushi
A
Kitajima
Masaki
M
Kitagawa
Yuko
Y
D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011846:Radio Waves; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*