Sentinel Lymph Node Detection In Gastric Cancer

Objective To investigate the detection of feasibility and accuracy of sentinel lymph nodes(SLN)with combining the cabon nanoparticles suspension and 99mTc-tincolloid injection in gastric cancer and assess its potential role in determining the rational extent of lymphadenectomy in gastric cancer surgery.Methods 37 patients of gastric cancer diagnosed as Tl—T3 stage were enrolled in this study.Endoscopic injection submucosally of was performed around the primary tumor 15-16h before operation.Immediately after laparotomy,cabon nanoparticles suspension injection was injected into subserosal layer adjacent to the tumor.After the cabon nanoparticles showing the lymph nodes mapping, SLNs were defined as the most radioactivity than surrounding tissue withγprobe.Standard radical gastrectomy with lymphadenectomy(D2 or D3)was performed in most of the patients,however,limited surgery was performed in early gastric cancer(EGC) when a rapid frozen examination indicated negative SLNs.All resected nodes were examined postoperatively by routine HE and rapid frozen cytokeratin immunohistochemistical stain and those negative SLNs were examined with further cytokeratin immunohistochemistical staining.The diagnostic accuracy,sensitivity,negative predictive value and false—negative rate of regional lymph node status on the basis of SLN status were calculated respectively.Results SLNs were dectected in 37 of 37 patients with a successful detection rate of 100%.The number of SLNs ranged from 1 to 5.With a mean value of 2.6 per case.The SLNs of gastric cancer were only found in Nl area in 86.5% of the cases,and only in N2 or N3 in 10.8%.The diagnostic accuracy,sensitivity,negative predictive value and false—negative rate were 100%,95.2%,16/17 and 5.9% respectively.Complete analysis of SLN upstaged two patients of gastric cancer.Conclusions The SLN concept is validated in gastric cancer.Combined —agent SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with gastric cancer and may indicate rational extent of lymphadenectomy for gastric cancer.