Lymphatic Mapping And Focused Analysis Of Sentinel Lymph Nodes Upstage Gastrointestinal Neoplasms

Objective: To identify intraoperative lymphatic mapping and sentinel lymphadenectomy is feasible in gastrointestinal neoplasms, and research the sentinel node status reflects the regional node status and focused analysis of the sentinel node improve staging. Methods: Lymphatic mapping had been performed in 74 patients with gastrointestinal neoplasm by injecting 1 ml of patent blue dye aroud the periphery of the neoplasm from November, 2003 to March ,2005. Blue-stained sentinel nodes were analyzed by hematoxylin-eosin staining and cytokeratin immunohistochemistry. Results: Lymphatic mapping identified at least 1 sentinel node in 72 patients(97%). Of the 44 cases with nodal metastasis ,40 (91%) patients had at least 1 positive sentinel node and 18 patients (41%) had nodal metastasis only in the sentinel node . In 13 cases tumor deposits were identified by immunohistochemistry only. In 2 cases lymphatic mapping identified aberrant lymphatic drainage that altered the extent of the lymphadenectomy. Conclusions: Lymphatic mapping and sentinel lymphadenectomy are feasible in gastrointestinal neoplasms and identify aberrant lymphatic drainage. The sentinel node status accurately reflects the regional node status.Focused analysis of the sentinel node increase the dection of micrometastases and may improve selection of patients for adjuvant treatment.