The sentinel node concept in adenocarcinomas of the distal esophagus and gastroesophageal junction.
OBJECTIVE
The sentinel node concept is of great value in the treatment of various malignancies. In this study we investigated whether the application of the sentinel node procedure is feasible in esophageal adenocarcinoma and whether it can tailor surgical treatment of the individual patient.


METHODS
In 40 patients with an adenocarcinoma of the distal esophagus or gastroesophageal junction, blue dye was injected around the tumor intraoperatively. Sentinel nodes (blue-stained) and nonsentinel nodes were identified and dissected during transhiatal esophagectomy. In sentinel nodes negative for tumor cells on routine hematoxylin-eosin examination, multilevel sectioning and immunohistochemical staining were performed to search for micrometastases.


RESULTS
The sentinel node procedure was technically successful in 39 of 40 patients (98%). The median number of sentinel nodes identified was 4. Sentinel nodes were present in more than 1 nodal station in 8 patients (21%). In 6 patients in whom the sentinel node was negative for metastasis, nonsentinel nodes were positive for tumor cells (false-negative rate 6/39 = 15%). Micrometastases and isolated tumor cells were detected in 7 of 19 patients (37%) with sentinel nodes, but this finding did not affect the false-negative rate.


CONCLUSIONS
Detection of sentinel nodes is technically feasible during esophagectomy for cancer. However, given the relatively high false-negative rate of 15% and the high frequency of sentinel nodes in more than 1 nodal station, the clinical relevance of the sentinel node concept (through application of the blue dye technique) in the current treatment of patients with an adenocarcinoma of the distal esophagus or gastroesophageal junction seems limited.
Grotenhuis
Brechtje A
BA
Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. b.grotenhuis@erasmusmc.nl
Wijnhoven
Bas P L
BP
van Marion
Ronald
R
van Dekken
Herman
H
Hop
Wim C
WC
Tilanus
Hugo W
HW
van Lanschot
J Jan B
JJ
van Eijck
Casper H J
CH
D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery*; D005188:False Negative Reactions; D005240:Feasibility Studies; D005260:Female; D006416:Hematoxylin / Q000008:administration & dosage / Q000032:analysis; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009333:Neck; D012394:Rosaniline Dyes / Q000008:administration & dosage / Q000032:analysis
D012394:Rosaniline Dyes; C008769:sulfan blue; D006416:Hematoxylin