Preoperative imaging of sentinel lymph nodes in gastric cancer using CT lymphography.
OBJECTIVE
Preoperative identification of the sentinel lymph node (SLN) in gastric cancer (GC) patients may have great advantages for the minimally invasive treatment. This study was performed to evaluate the possibility of preoperative SLN detection using CT lymphography.


METHODS
Fourteen patients with early GC were enrolled. CT images were obtained before and at 1, 3, and 5 minutes after endoscopic submucosal peritumoral injection of 2 mL iopamidol. For patients with clearly identified SLNs, to make comparisons with the CT lymphography results, intraoperative SLN detection was performed using subserosally injected Indocyanine green (ICG) lymphography and ex vivo ICG and iopamidol lymphography using mammography was also performed.


RESULTS
CT lymphography clearly visualized draining lymphatics and SLNs in 4 (28.6%) out of 14 patients. All clearly visualized SLNs (one to three SLNs per patient) under preoperative imaging were detected in the same location by intraoperative ICG lymphography and ex vivo ICG and iopamidol lymphography using mammography. All preoperative SLN detections were observed with the primary tumors in the lower third of the stomach.


CONCLUSIONS
Although our study demonstrated a SLN detection rate of less than 30%, CT lymphography with radio-contrast showed potential as a method of preoperative SLN detection for GC.
Hyung
Woo Jin
WJ
Department of Radiology, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea.
Kim
Yong Soo
YS
Lim
Joon Seok
JS
Kim
Myeong-Jin
MJ
Noh
Sung Hoon
SH
Kim
Ki Whang
KW
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007479:Iopamidol; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008220:Lymphography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011300:Preoperative Care; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*
D007479:Iopamidol