Clinical surgery–international
Sentinel lymph node mapping with technetium-99m colloidal rhenium sulfide in patients with gastric carcinoma

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Abstract

Background

The objective of this study was to determine, with the use of technetium-99m colloidal rhenium sulfide, whether the concept of sentinel lymph nodes (SLNs) is applicable to gastric cancers.

Methods

Fifty-nine gastric cancer patients underwent radical gastrectomy and SLN mapping with an intraoperative hand-held γ probe. After surgery, each transected lymph node was measured for radioisotope (RI) activities by a well-type scintillation counter.

Results

SLNs were detectable in 57 (96%) of 59 patients. The sensitivity, specificity, and diagnostic accuracy were calculated to be 83.3%, 100%, and 92.9%, respectively. Sensitivity was 100% in the T1 group, 91.6% in the T2 group, and 62.5% in the T3 group. When RI activities were measured with a well-type scintillation counter, every metastatic non-SLN was found to be situated in the same lymphatic basin as the SLNs.

Conclusion

The SLN concept is applicable to patients with early gastric cancer (T1). SLN mapping is suitable for identifying the lymphatic basin in cases of gastric cancer.

Section snippets

Patients

Fifty-nine patients (41 males and 18 females) with histologically confirmed primary gastric adenocarcinoma and without clinically diagnosed lymph node metastasis and distant metastasis were prospectively enrolled in this study. Patients with a diagnosis of clinical T1, T2, or T3N0H0 (liver metastasis) M0 (distant metastasis) status were enrolled in this study. Furthermore, differentiated mucosal tumors of less than 2 cm without an ulcer formation were excluded for endoscopic mucosal resection,

Patient characteristics

The clinicopathologic characteristics of patients enrolled in the study are summarized in Table 1. The depth of cancer invasion was T1 in 28 patients, T2 in 19, and T3 in 12. There were no complications or side effects related to the injection of technetium-99m colloidal rhenium sulfide.

Lymph node status

A total of 2049 nodes were removed; the median number of resected nodes per patient was 35 (range 5 to 81). One hundred twenty-four (6.0%) of these nodes were positive for carcinoma metastasis in permanent

Comments

Although SLN mapping is proving to be a useful technique, there is no standard technique for gastric cancer in Japan and other countries [5], [6], [7], [8] Furthermore, it has been reported that the use of SLN biopsies during gastric cancer surgery cannot be implemented until diagnostic procedures are improved [9]. In this study, SLN mapping with technetium-99m colloidal rhenium sulfide was demonstrated to be effective for detecting SLNs in individuals with early gastric cancer. The SLN

Conclusion

SLN mapping with the use of technetium-99m colloidal rhenium sulfide can be used to detect the sentinel lymph nodes in patients with clinical T1 gastric cancer. However, several issues, such as the sensitivity of intraoperative pathologic examination and the detection of the so-called skip metastasis, remain to be resolved before wide clinical application of this procedure. At present, SLN mapping is suitable for the identification of the lymphatic basin and the performance of selective

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Supported by Grant No. 13671280 from the Ministry of Education, Science, and Culture of Japan.

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