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Efficacy of Different Technical Procedures for Sentinel Lymph Node Biopsy in Gastric Cancer Staging

Item Type:Article
Title:Efficacy of Different Technical Procedures for Sentinel Lymph Node Biopsy in Gastric Cancer Staging
Creators Name:Gretschel, S. and Bembenek, A. and Huenerbein, M. and Dresel, S. and Schneider, W. and Schlag, P.M.
Abstract:Background: The clinical impact of sentinel lymph node biopsy (SLNB) in gastric cancer is controversial. We performed a prospective trial to compare different methods: radiocolloid method (RM), dye method (DM), and both methods simultaneously (dual method, or DUM) for reliability and therapeutic consequences. Methods: RM and DM were applied in 35 gastric cancer patients. After endoscopic peritumoral injection of (99m)Tc-colloid and Patent Blue V, the positions of all blue sentinel lymph nodes (SLNs) were recorded, and the SLNs microscopically examined by hematoxylin and eosin, step sections, and immunohistochemistry. Results: RM, DM, and DUM identified the SLNs in 34 (97%) of 35 patients. The sensitivity for the prediction of positive lymph node status for RM was 22 (92%) of 24, for DM 16 (66%) of 24, and for DUM 22 (92%) of 24. In 7 of 17 (RM), 5 of 15 (DM), and 7 of 17 (DUM) patients classified as N0 by routine hematoxylin and eosin staining, micrometastases or isolated tumor cells were found in the SLN (upstaging) after focused examination. If only a limited lymph node dissection of the SLN basins would have been performed in patients, residual lymph node metastases were left in 9 of 24 (RM), in 7 of 34 (DM), and in 5 of 24 (DUM) of patients with node-positive disease. Conclusions: Use of RM was superior. DUM did not further increase the sensitivity. A limited lymph node dissection-i.e., lymphatic basin in patients with SLN-positive disease-is associated with a high risk of residual metastases. Patients with negative SLNs may be selected for a limited surgical procedure if they meet certain criteria.
Keywords:Gastric cancer, Sentinel lymph node biopsy, Dye method, Radiocolloid method
Source:Annals of Surgical Oncology
ISSN:1068-9265
Publisher:Springer (Germany)
Volume:14
Number:7
Page Range:2028-2035
Date:July 2007
Official Publication:https://doi.org/10.1245/s10434-007-9367-y
PubMed:View item in PubMed

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