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Clinical Implementations of Preoperative Computed Tomography Lymphography in Gastric Cancer: A Comparison with Dual Tracer Methods in Sentinel Node Navigation Surgery

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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 99mTc-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.

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Acknowledgment

This study was supported by Seoul National University Bundang Hospital (Project No. 02-2009-013).

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea

    Ju-Hee Lee MD, Do Joong Park MD & Hyung-Ho Kim MD

  2. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Do Joong Park MD & Hyung-Ho Kim MD

  3. Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi, South Korea

    Young Hoon Kim MD

  4. Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi, South Korea

    Cheol-Min Shin MD

  5. Department of Pathology, Seoul National University Bundang Hospital, Gyeonggi, South Korea

    Hye Seung Lee MD

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  1. Ju-Hee Lee MD
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  2. Do Joong Park MD
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  4. Cheol-Min Shin MD
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Correspondence to Hyung-Ho Kim MD.

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Lee, JH., Park, D.J., Kim, Y.H. et al. Clinical Implementations of Preoperative Computed Tomography Lymphography in Gastric Cancer: A Comparison with Dual Tracer Methods in Sentinel Node Navigation Surgery. Ann Surg Oncol 20, 2296–2303 (2013). https://doi.org/10.1245/s10434-012-2855-8

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  • DOI: https://doi.org/10.1245/s10434-012-2855-8

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