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KMID : 0371320030650030223
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Journal of the Korean Surgical Society
2003 Volume.65 No. 3 p.223 ~ p.227
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Sentinel Node Biopsy in Gastric Cancer
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Kim Min-Chan
Jung Ghap-Joong
Choi Seok-Reyol
Kang Do-Young
Roh Mee-Sook
Jeong Jin-Sook
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Abstract
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Purpose :The sentinel lymph node (SLN) is the first draining node from the primary lesions, and is the first site of lymph node metastasis in malignancies. The aim of this study was to determine the feasibility of a SLN biopsy in patients with gastric cancer to assess the regional lymph node status.
Methods :A SLN biopsy was performed in 46 consecutive gastric cancer patients, with preoperative imaging stages of T1/T2 N0 and M0. Three hours prior to each operation, a 99mTc tin-colloid (2.0 ml, 1.0 mCi) was endoscopically injected into the gastric submucosa around the primary tumor. Subsequently, serial lymphoscintigraphy was performed using a dual head gamma camera. After the SLN biopsy had been performed using a gamma probe, the patients underwent a radical gastrectomy (D2 or D2+α). The SLNs were cut and immediately frozen-sectioned. A paraffin block was then produced for permanent hematoxylin-eosin staining and immunohistochemistry (IHC).
Results :SLNs were successfully identified in 43 of the 46 patients (success rate, 93.5%), at an average of 2 (range, 1~8) per patient. The positive and negative predictive values, sensitivity and specificity of the SLN biopsy were 100 (11/11), 93.8 (30/32), 84.6% (11/13) and 100% (30/30), respectively. SLNs were located at the level I, I+II and II lymph nodes in 38 (88.4%), 2 (4.7%) and 3 (7.0%), respectively. No micrometastases of the SLNs was found on the IHC for cytokeratin.
Conclusion :A sentinel lymph node (SLN) biopsy, using a radioisotope, in patients with gastric cancer is a technically feasible and accurate technique, and is a minimally invasive approach for assessing the nodal status in patients.
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KEYWORD
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Sentinel lymph node biopsy, Stomach neoplasm, Radioisotope, Lymphatic metastasis,
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