title: Lymph node micrometastasis in gastrointestinal tract cancer--a clinical aspect.
abstract: Lymph node micrometastasis (LNM) can now be detected thanks to the development of various biological methods such as immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR). Although several reports have examined LNM in various carcinomas, including gastrointestinal (GI) cancer, the clinical significance of LNM remains controversial. Clinically, the presence of LNM is particularly important in patients without nodal metastasis on routine histological examination (pN0), because patients with pN0 but with LNM already in fact have metastatic potential. However, at present, several technical obstacles are impeding the detection of LNM using methods such as IHC or RT-PCR. Accurate evaluation should be carried out using the same antibody or primer and the same technique in a large number of patients. The clinical importance of the difference between LNM and isolated tumor cells (≤0.2 mm in diameter) will also be gradually clarified. It is important that the results of basic studies on LNM are prospectively introduced into the clinical field. Rapid diagnosis of LNM using IHC and RT-PCR during surgery would be clinically useful. Currently, minimally invasive treatments such as endoscopic submucosal dissection and laparoscopic surgery with individualized lymphadenectomy are increasingly being performed. Accurate diagnosis of LNM would clarify issues of curability and safety when performing such treatments. In the near future, individualized lymphadenectomy will develop based on the establishment of rapid, accurate diagnosis of LNM.
authors.affiliation: Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan, natsugoe@m2.kufm.kagoshima-u.ac.jp.
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
authors.forename: Takaaki
authors.initials: T
authors.lastname: Arigami
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Uenosono
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Yanagita
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nakajo
authors.forename: Masataka
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okumura
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kijima
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sakoda
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mataki
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Uchikado
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Mori
authors.forename: Kosei
authors.initials: K
authors.lastname: Maemura
authors.forename: Sumiya
authors.initials: S
authors.lastname: Ishigami
mesh_terms: D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology*; D061206:Neoplasm Micrometastasis / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy