title: Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan.
abstract: OBJECTIVE
  Complicated gastric lymphatic drainage potentially undermines the utility of sentinel node (SN) biopsy in patients with gastric cancer. Encouraged by several favorable single-institution reports, we conducted a multicenter, single-arm, phase II study of SN mapping that used a standardized dual tracer endoscopic injection technique.
  
  
  METHODS
  Patients with previously untreated cT1 or cT2 gastric adenocarcinomas < 4 cm in gross diameter were eligible for inclusion in this study. SN mapping was performed by using a standardized dual tracer endoscopic injection technique. Following biopsy of the identified SNs, mandatory comprehensive D2 or modified D2 gastrectomy was performed according to current Japanese Gastric Cancer Association guidelines.
  
  
  RESULTS
  Among 433 patients who gave preoperative consent, 397 were deemed eligible on the basis of surgical findings. SN biopsy was performed in all patients, and the SN detection rate was 97.5% (387 of 397). Of 57 patients with lymph node metastasis by conventional hematoxylin and eosin staining, 93% (53 of 57) had positive SNs, and the accuracy of nodal evaluation for metastasis was 99% (383 of 387). Only four false-negative SN biopsies were observed, and pathologic analysis revealed that three of those biopsies were pT2 or tumors > 4 cm. We observed no serious adverse effects related to endoscopic tracer injection or the SN mapping procedure.
  
  
  CONCLUSIONS
  The endoscopic dual tracer method for SN biopsy was confirmed as safe and effective when applied to the superficial, relatively small gastric adenocarcinomas included in this study.
authors.affiliation: Yuko Kitagawa, Hiroya Takeuchi, and Masaki Kitajima, Keio University School of Medicine; Yu Takagi, Tokyo Medical University, Tokyo; Shoji Natsugoe, Yoshikazu Uenosono, and Takashi Aikou, Kagoshima University Graduate School of Medical Science, Kagoshima; Masanori Terashima, Fukushima Medical University, Fukushima; Nozomu Murakami, Ishikawa Prefectural Central Hospital; Takashi Fujimura, Shinichi Kinami, and Koichi Miwa, Kanazawa University Hospital, Ishikawa; Hironori Tsujimoto, National Defense Medical College; Nobunari Yoshimizu, Saitama Social Insurance Hospital, Saitama; Hideki Hayashi, Graduate School of Medicine, Chiba University, Chiba; Akinori Takagane, Iwate Medical University, Iwate; Yasuhiko Mohri, Mie University Graduate School of Medicine, Mie; Kazuhito Nabeshima, Tokai University; Satoshi Morita, Yokohama City University Graduate School of Medicine, Kanagawa; and Junichi Sakamoto, Nagoya University Graduate School of Medicine, Aichi, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Hiroya
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Yu
authors.initials: Y
authors.lastname: Takagi
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
authors.forename: Masanori
authors.initials: M
authors.lastname: Terashima
authors.forename: Nozomu
authors.initials: N
authors.lastname: Murakami
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujimura
authors.forename: Hironori
authors.initials: H
authors.lastname: Tsujimoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Nobunari
authors.initials: N
authors.lastname: Yoshimizu
authors.forename: Akinori
authors.initials: A
authors.lastname: Takagane
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Mohri
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Nabeshima
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Uenosono
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kinami
authors.forename: Junichi
authors.initials: J
authors.lastname: Sakamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Takashi
authors.initials: T
authors.lastname: Aikou
authors.forename: Koichi
authors.initials: K
authors.lastname: Miwa
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery