title: Initial experience in sentinel lymph node detection in pancreatic cancer.
abstract: BACKGROUND
  The local recurrence of pancreatic cancer is around 30% when complete resection can be achieved. Extended lymphatic resections may improve survival, but increases severe morbidity. As accurate patient selection should be mandatory, a new method is presented for pancreatic sentinel lymph node (SLN) detection with lymphoscintigraphy and gamma probe.
  
  
  METHODS
  Seven patients with cT2N0M0 pancreatic head cancer were enrolled between 2009 and 2012 in this prospective study. One day prior to surgery, preoperative lymphoscintigraphy with echoendoscopic intratumoural administration of Tc(99m)-labelled nanocolloid was performed, with planar and SPECT-CT images obtained 2h later. Gamma probe detection of SLN was also carried out during surgery.
  
  
  RESULTS
  Radiotracer administration was feasible in all patients. Scintigraphy images showed inter-aortocaval lymph nodes in 2 patients, hepatoduodenal ligament lymph nodes in 1, intravascular injection in 3, intestinal transit in 5, and main pancreatic duct visualisation in 1. Surgical resection could only be achieved in 4 patients owing to locally advanced disease. Intraoperative SLN detection was accomplished in 2 patients, both with negative results. Only in one patient could SLN be confirmed as truly negative by final histopathological analysis.
  
  
  CONCLUSIONS
  This new method of pancreatic SLN detection is technically feasible, but challenging. Our preliminary results with 7 patients are not sufficient for clinical validation.
authors.affiliation: Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: mbeisani@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Beisani
authors.affiliation: Department of Nuclear Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: isaroca@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Roca
authors.affiliation: Department of Nuclear Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Cardenas
authors.affiliation: Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Blanco
authors.affiliation: Department of Digestive Endoscopy, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Abu-Suboh
authors.affiliation: Department of Digestive Endoscopy, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Dot
authors.affiliation: Department of Digestive Endoscopy, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: J R
authors.initials: JR
authors.lastname: Armengol
authors.affiliation: Department of Surgery, Hospital Arnau de Vilanova, University of Lleida, Lleida, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: Olsina
authors.affiliation: Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Balsells
authors.affiliation: Department of HPB Surgery, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Charco
authors.affiliation: Department of Nuclear Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Castell
mesh_terms: D006801:Humans; D061305:Lymphoscintigraphy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging*
keywords: Cancer de páncreas; Ganglio Centinela; Linfogammagrafía; Lymphoscintigraphy; Pancreatic cancer; Sentinel node