title: Preferentially examined sentinel nodes for sentinel node navigation surgery in gastric cancer.
abstract: The intraoperative examination of the sentinel nodes (SNs) is crucial for correctly performing SN navigation surgery (SNNS). Frozen-section diagnosis is ordinarily used; however, when several SNs are being assessed in gastric cancer, which has numerous regional lymph nodes, it is difficult to examine them all correctly within the short duration of surgery. In the present study, we aimed to determine the SNs that should be preferentially examined during SNNS in gastric cancer. A total of 824 SNs were examined in 113 patients with clinically determined T1-2 gastric cancer and no apparent lymph node metastasis. We focused on the accumulation of tracers expressed by hot nodes (HNs) using the radioisotope (RI) method and green nodes (GNs) using the dye-guided method and measured the radioactivity count of the HNs (RI count). We compared these parameters between 35 metastatic and 789 non-metastatic SNs. The percentage of metastasis-positive SNs that were radioactively 'hot' and dyed green was higher compared with that of the negative SNs (89 vs. 43%, respectively; P<0.01). The RI counts of the metastasis-positive SNs were higher compared with those of the negative SNs [median (range): 361 (0-10,670) vs. 53 (0-9,931), respectively; P<0.01]. The area under the receiver operating characteristic curve of the RI count was 0.69 (95% CI: 0.60-0.78). Therefore, when assessing several SNs, those with higher RI counts (HNs and GNs) should be preferentially examined. Further accumulation of cases is required to establish the cut-off value for the diagnosis of metastasis based on the RI count.
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan ; Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Yaguchi
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Tsujimoto
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hiraki
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ichikura
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hase
keywords: gastric cancer; intraoperative examination; sentinel node; sentinel node navigation surgery