title: Clinical implementations of preoperative computed tomography lymphography in gastric cancer: a comparison with dual tracer methods in sentinel node navigation surgery.
abstract: BACKGROUND
  Current sentinel node (SN) detection techniques require a learning period and tracers have many disadvantages for practical use. The purpose of this study was to evaluate the feasibility of preoperative computed tomography (CT) lymphography using lipiodol for detecting SNs in gastric cancer.
  
  
  METHODS
  A total of 24 patients who underwent laparoscopic surgery for early gastric cancer were enrolled in this study. Noncontrast CT images were obtained 1-2 h after endoscopic submucosal peritumoral injection of 1 mL of lipiodol the day before surgery. The final sentinel basins (SBs) were decided by the dual tracer method (indocyanine green plus (99m)Tc-antimony sulfur colloid) during laparoscopic gastrectomy. SN detection rate by preoperative CT lymphography using lipiodol and agreement between CT lymphography versus dual tracer method were evaluated. The agreement was confirmed with soft X-ray radiography of detected SBs.
  
  
  RESULTS
  Technical failure of endoscopic lipiodol injection occurred in one patient. SNs were successfully detected in the remaining 23 patients (95.8 %), whereas the intraoperative SB detection rate using the dual method was 100 %. The agreement rate, defined as the concordance between two methods or inclusion of SNs detected by CT lymphography in SBs by the dual tracer method, was 87 %.
  
  
  CONCLUSIONS
  Our initial experience of CT lymphography using lipiodol shows good potential in predicting SBs of gastric cancer preoperatively. However, SN detection by CT lymphography and the dual method should be applied complementarily in gastric cancer because discrepancies between these methods occur.
authors: Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea.
authors: Ju-Hee
authors: JH
authors: Lee
authors: Do Joong
authors: DJ
authors: Park
authors: Young Hoon
authors: YH
authors: Kim
authors: Cheol-Min
authors: CM
authors: Shin
authors: Hye Seung
authors: HS
authors: Lee
authors: Hyung-Ho
authors: HH
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000965:Antimony; D004396:Coloring Agents; D003287:Contrast Media; D004998:Ethiodized Oil; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D010535:Laparoscopy; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D017556:Technetium Compounds; D014057:Tomography, X-Ray Computed
chemical_list: D004396:Coloring Agents; D003287:Contrast Media; D019275:Radiopharmaceuticals; D017556:Technetium Compounds; C019096:technetium Tc 99m antimony sulfide; D004998:Ethiodized Oil; D000965:Antimony; D007208:Indocyanine Green