Evaluation of a Sentinel Lymph Node Biopsy with Patent Blue in Locally Advanced Gastric Cancer
,
Abstract
Background: A sentinel lymph node (SLN) biopsy is an interesting issue in the field of surgical oncology and has recently been introduced to the treatment of gastric cancer. The purpose of this study is to assess accuracy, sensitivity, specificity, and false negative rates (FNRs) of SLN biopsies, and to ascertain whether or not this procedure is useful for locally advanced gastric cancer.
Methods: From December 2013 to March 2014, 22 patients with gastric cancer were enrolled in this study. After laparotomy, patent blue was injected around the tumor subserosaly, resection was then done, and SLNs were detected on a back table. Afterward, D2 dissection was carried out. Finally, SLNs and other specimens were submitted for permanent pathology.
Results: SLNs were detected in 20 of 22 patients. The total number of SLNs was 87. SLNs were positive in 7 patients, and the total number of positive SLNs was 17. In three patients, the SLNs were negative, whereas other LNs were positive, with an FNR of 15%. 18 patients received neoadjuvant. Complete pathologic responses with negative LNs were seen in 3 patients. Accuracy, sensitivity, specificity, and negative predictive values were 80%, 66%, 90%, and 76%, respectively.
Conclusions: This research demonstrated that SLN mapping in advanced gastric cancer is an appropriate method with acceptable levels of accuracy, sensitivity, and negative predictive values, even in those patients who received neoadjuvant treatment.
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2. Wang Z, Dong ZY, Chen JQ, Liu JL. Diagnostic value of sentinel lymph node biopsy in gastric cancer: a metaanalysis.Ann Surg Oncol. 2012; 19(5): 1541-50.
3. Can MF, Yagci G, Cetiner S. Sentinel lymph node biopsy for gastric cancer: Where do we stand? World J Gastrointest Surg. 2011; 3(9): 131-7.
4. Cozzaglio L, Bottura R, Di Rocco M, Gennari L, Doci R.Sentinel lymph node biopsy in gastric cancer: possible applications and limits. Eur J Surg Oncol. 2011; 37(1):55-9.
5. Su XH, Chen Q, Sun L, Wu H, Pan WM, Chen GB, et al.Location of sentinel lymph node in gastric cancer: A modified, painless and noninvasive approach. Chin J Cancer Res. 2010; 22(1): 55-61.
6. Ryu KW, Lee JH, Kim HS, Kim YW, Choi IJ, Bae JM.Prediction of lymph nodes metastasis by sentinel node biopsy in gastric cancer. Eur J Surg Oncol. 2003; 29(10):895-9.
7. Huang B, Wang Z, Sun Z, Zhao B, Xu H. A novel insight of sentinel lymph node concept based on 1-3 positive nodes in patients with pT1-2 gastric cancer. BMC Cancer. 2011; 11: 18.
8. Zilberstein B, Martins BC, Jacob CE, Bresciani C,Lopasso FP, de Cleva R, et al. Complications of gastrectomy with lymphadenectomy in gastric cancer.Gastric Cancer 2004; 7(4): 254-9.
9. Lips DJ, Schutte HW, van der Linden RL, Dassen AE,Voogd AC, Bosscha K. Sentinel lymph node biopsy to direct treatment in gastric cancer. A systematic review of the literature. Eur J Surg Oncol. 2011; 37(8): 655-61.
10. Mochiki E, Kuwano H, Kamiyama Y, Aihara R,Nakabayashi T, Katoh H, et al. Sentinel lymph node mapping with technetium-99m colloidal rhenium sulfide in patients with gastric carcinoma. Am J Surg. 2006;191(4): 465-9.
11. Cardoso R, Bocicariu A, Dixon M, Yohanathan L,Seevaratnam R, Helyer L, et al. What is the accuracy of sentinel lymph node biopsy for gastric cancer? A systematic review. Gastric Cancer. 2012; 15(Suppl 1):
S48-S59.
12. Takeuchi H, Kitagawa Y. New sentinel node mapping technologies for early gastric cancer. Ann Surg Oncol.2013; 20(2): 522-32.
13. Gould EA, Winship T, Philbin PH, Kerr HH.Observations on a "sentinel node" in cancer of the parotid. Cancer. 1960; 13: 77-8.
14. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977; 39(2): 456-66.
15. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg.1992; 127(4): 392-9.
16. Palaia R, Cremona F, Delrio P, Izzo F, Ruffolo F, Parisi V. Sentinel node biopsy in gastric cancer. J Chemother.1999; 11(3): 230-1.
17. Rabin I, Chikman B, Lavy R, Poluksht N, Halpern Z,Wassermann I, et al. The accuracy of sentinel node mapping according to T stage in patients with gastric cancer. Gastric Cancer. 2010; 13(1): 30-5.
18. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14(2): 101-12.
19. Hiratsuka M, Miyashiro I, Ishikawa O, Furukawa H,Motomura K, Ohigashi H, et al. Application of sentinel node biopsy to gastric cancer surgery. Surgery. 2001;129(3): 335-40.
20. Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N,Watanabe M, et al. The role of the sentinel lymph node in gastrointestinal cancer. Surg Clin North Am. 2000; 80(6):1799-809.
21. Ichikura T, Morita D, Uchida T, Okura E, Majima T,Ogawa T, et al. Sentinel node concept in gastric carcinoma. World J Surg. 2002; 26(3): 318-22.
22. Miyashiro I, Miyoshi N, Hiratsuka M, Kishi K, Yamada T, Ohue M, et al. Detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging: comparison with infrared imaging. Ann Surg Oncol. 2008; 15(6): 1640-3.
23. Kelder W, Nimura H, Takahashi N, Mitsumori N, van Dam GM, Yanaga K. Sentinel node mapping with indocyanine green (ICG) and infrared ray detection in early gastric cancer: an accurate method that enables a limited lymphadenectomy. Eur J Surg Oncol. 2010;36(6): 552-8.
24. Morita D, Tsuda H, Ichikura T, Kimura M, Aida S,Kosuda S, et al. Analysis of sentinel node involvement in gastric cancer. Clin Gastroenterol Hepatol. 2007; 5(9):1046-52.
25. Lee JH, Ryu KW, Kim CG, Kim SK, Choi IJ, Kim YW, et al. Comparative study of the subserosal versus submucosal dye injection method for sentinel node biopsy in gastric cancer. Eur J Surg Oncol. 2005; 31(9): 965-8.
26. Toth D, Kincses Z, Plosz J, Torok M, Kovacs I, Kiss C,et al. Value of sentinel lymph node mapping using a blue dye-only method in gastric cancer: a single-center experience from North-East Hungary. Gastric Cancer.2011; 14(4): 360-4.
27. Yaguchi Y, Ichikura T, Ono S, Tsujimoto H, Sugasawa H, Sakamoto N, et al. How should tracers be injected to detect for sentinel nodes in gastric cancer—submucosally from inside or subserosally from outside of the stomach? J Exp Clin Cancer Res. 2008; 27: 79.
28. Isozaki H, Kimura T, Tanaka N, Satoh K, Matsumoto S,Ninomiya M, et al. An assessment of the feasibility of sentinel lymph node-guided surgery for gastric cancer.Gastric Cancer. 2004; 7(3): 149-53.
29. Song X, Wang L, Chen W, Pan T, Zhu H, Xu J, et al.Lymphatic mapping and sentinel node biopsy in gastric cancer. Am J Surg. 2004; 187(2): 270-3.
30. Lee SE, Lee JH, Ryu KW, Cho SJ, Lee JY, Kim CG, et al. Sentinel node mapping and skip metastases in patients with early gastric cancer. Ann Surg Oncol. 2009; 16(3):603-8.
31. Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T,Nonomura A. Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg. 2003; 90(2):178-82.
32. Ishizaki M, Kurita A, Kubo Y, Takashima S, Nishina T,Nishimura E. Evaluation of sentinel node identification with isosulfan blue in gastric cancer. Eur J Surg Oncol.2006; 32(2): 191-6.
33. Arigami T, Natsugoe S, Uenosono Y, Mataki Y, Ehi K Higashi H, et al. Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction. Ann Surg. 2006; 243(3): 341-7.
34. Hayashi H, Ochiai T, Mori M, Karube T, Suzuki T, Gunji Y, et al. Sentinel lymph node mapping for gastric cancer using a dual procedure with dye- and gamma probeguided techniques. J Am Coll Surg. 2003; 196(1): 68-74.
35. Wang LB, Shen JG, Dong LF, Xu CY, Chen WJ, Xie SD,et al. Laparoscopic local resection based on sentinel node evaluation for early gastric cancer: a preliminary report. J Gastrointest Surg. 2008; 12(8): 1359-63.
36. Simsa J, Hoch J, Leffler J, Schwarz J, Pospisil R,Vajtrova R. Sentinel node biopsy in gastric cancer:preliminary results. Acta Chir Belg. 2003; 103(3): 270-3.
37. Lee JH, Ryu KW, Nam BH, Kook MC, Cho SJ, Lee JY,et al. Factors associated with detection failure and falsenegative sentinel node biopsy findings in gastric cancer:results of prospective single center trials. J Surg Oncol.2009; 99(3): 137-42.
38. Miyashiro I, Hiratsuka M, Kishi K, Takachi K, Yano M,Takenaka A, et al. Intraoperative diagnosis using sentinel node biopsy with indocyanine green dye in gastric cancer surgery: an institutional trial by experienced surgeons.Ann Surg Oncol. 2013; 20(2): 542-6.
39. Ajisaka H, Miwa K. Micrometastases in sentinel nodes of gastric cancer. Br J Cancer. 2003; 89(4): 676-80.
40. Lee YJ, Ha WS, Park ST, Choi SK, Hong SC, Park JW.Which biopsy method is more suitable between a basin dissection and pick-up biopsy for sentinel nodes in laparoscopic sentinel-node navigation surgery (LSNNS) for gastric cancer? J Laparoendosc Adv Surg Tech A.2008; 18(3): 357-63.
41. Kim MC, Kim HH, Jung GJ, Lee JH, Choi SR, Kang DY,et al. Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer. Ann Surg. 2004;239(3): 383-7.
42. Yasuda K, Inomata M, Fujii K, Shiraishi N, Adachi Y,Kitano S. Superficially spreading cancer of the stomach.Ann Surg Oncol. 2002; 9(2): 192-6.
43. Isozaki H, Okajima K, Fujii K. Histological evaluation of lymph node metastasis on serial sectioning in gastric cancer with radical lymphadenectomy.Hepatogastroenterology. 1997; 44(16): 1133-6.
44. Gretschel S, Bembenek A, Hunerbein M, Dresel S,Schneider W, Schlag PM. Efficacy of different technical procedures for sentinel lymph node biopsy in gastric cancer staging. Ann Surg Oncol. 2007; 14(7): 2028-35.
45. Osaka H, Yashiro M, Sawada T, Katsuragi K, Hirakawa K. Is a lymph node detected by the dye-guided method a true sentinel node in gastric cancer? Clin Cancer Res.2004; 10(20): 6912-8.
46. Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer. 2011; 14(2): 113-23.
47. Cunningham D, Allum WH, Stenning SP, Thompson JN,Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006; 355(1):11-20
2. Wang Z, Dong ZY, Chen JQ, Liu JL. Diagnostic value of sentinel lymph node biopsy in gastric cancer: a metaanalysis.Ann Surg Oncol. 2012; 19(5): 1541-50.
3. Can MF, Yagci G, Cetiner S. Sentinel lymph node biopsy for gastric cancer: Where do we stand? World J Gastrointest Surg. 2011; 3(9): 131-7.
4. Cozzaglio L, Bottura R, Di Rocco M, Gennari L, Doci R.Sentinel lymph node biopsy in gastric cancer: possible applications and limits. Eur J Surg Oncol. 2011; 37(1):55-9.
5. Su XH, Chen Q, Sun L, Wu H, Pan WM, Chen GB, et al.Location of sentinel lymph node in gastric cancer: A modified, painless and noninvasive approach. Chin J Cancer Res. 2010; 22(1): 55-61.
6. Ryu KW, Lee JH, Kim HS, Kim YW, Choi IJ, Bae JM.Prediction of lymph nodes metastasis by sentinel node biopsy in gastric cancer. Eur J Surg Oncol. 2003; 29(10):895-9.
7. Huang B, Wang Z, Sun Z, Zhao B, Xu H. A novel insight of sentinel lymph node concept based on 1-3 positive nodes in patients with pT1-2 gastric cancer. BMC Cancer. 2011; 11: 18.
8. Zilberstein B, Martins BC, Jacob CE, Bresciani C,Lopasso FP, de Cleva R, et al. Complications of gastrectomy with lymphadenectomy in gastric cancer.Gastric Cancer 2004; 7(4): 254-9.
9. Lips DJ, Schutte HW, van der Linden RL, Dassen AE,Voogd AC, Bosscha K. Sentinel lymph node biopsy to direct treatment in gastric cancer. A systematic review of the literature. Eur J Surg Oncol. 2011; 37(8): 655-61.
10. Mochiki E, Kuwano H, Kamiyama Y, Aihara R,Nakabayashi T, Katoh H, et al. Sentinel lymph node mapping with technetium-99m colloidal rhenium sulfide in patients with gastric carcinoma. Am J Surg. 2006;191(4): 465-9.
11. Cardoso R, Bocicariu A, Dixon M, Yohanathan L,Seevaratnam R, Helyer L, et al. What is the accuracy of sentinel lymph node biopsy for gastric cancer? A systematic review. Gastric Cancer. 2012; 15(Suppl 1):
S48-S59.
12. Takeuchi H, Kitagawa Y. New sentinel node mapping technologies for early gastric cancer. Ann Surg Oncol.2013; 20(2): 522-32.
13. Gould EA, Winship T, Philbin PH, Kerr HH.Observations on a "sentinel node" in cancer of the parotid. Cancer. 1960; 13: 77-8.
14. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977; 39(2): 456-66.
15. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg.1992; 127(4): 392-9.
16. Palaia R, Cremona F, Delrio P, Izzo F, Ruffolo F, Parisi V. Sentinel node biopsy in gastric cancer. J Chemother.1999; 11(3): 230-1.
17. Rabin I, Chikman B, Lavy R, Poluksht N, Halpern Z,Wassermann I, et al. The accuracy of sentinel node mapping according to T stage in patients with gastric cancer. Gastric Cancer. 2010; 13(1): 30-5.
18. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14(2): 101-12.
19. Hiratsuka M, Miyashiro I, Ishikawa O, Furukawa H,Motomura K, Ohigashi H, et al. Application of sentinel node biopsy to gastric cancer surgery. Surgery. 2001;129(3): 335-40.
20. Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N,Watanabe M, et al. The role of the sentinel lymph node in gastrointestinal cancer. Surg Clin North Am. 2000; 80(6):1799-809.
21. Ichikura T, Morita D, Uchida T, Okura E, Majima T,Ogawa T, et al. Sentinel node concept in gastric carcinoma. World J Surg. 2002; 26(3): 318-22.
22. Miyashiro I, Miyoshi N, Hiratsuka M, Kishi K, Yamada T, Ohue M, et al. Detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging: comparison with infrared imaging. Ann Surg Oncol. 2008; 15(6): 1640-3.
23. Kelder W, Nimura H, Takahashi N, Mitsumori N, van Dam GM, Yanaga K. Sentinel node mapping with indocyanine green (ICG) and infrared ray detection in early gastric cancer: an accurate method that enables a limited lymphadenectomy. Eur J Surg Oncol. 2010;36(6): 552-8.
24. Morita D, Tsuda H, Ichikura T, Kimura M, Aida S,Kosuda S, et al. Analysis of sentinel node involvement in gastric cancer. Clin Gastroenterol Hepatol. 2007; 5(9):1046-52.
25. Lee JH, Ryu KW, Kim CG, Kim SK, Choi IJ, Kim YW, et al. Comparative study of the subserosal versus submucosal dye injection method for sentinel node biopsy in gastric cancer. Eur J Surg Oncol. 2005; 31(9): 965-8.
26. Toth D, Kincses Z, Plosz J, Torok M, Kovacs I, Kiss C,et al. Value of sentinel lymph node mapping using a blue dye-only method in gastric cancer: a single-center experience from North-East Hungary. Gastric Cancer.2011; 14(4): 360-4.
27. Yaguchi Y, Ichikura T, Ono S, Tsujimoto H, Sugasawa H, Sakamoto N, et al. How should tracers be injected to detect for sentinel nodes in gastric cancer—submucosally from inside or subserosally from outside of the stomach? J Exp Clin Cancer Res. 2008; 27: 79.
28. Isozaki H, Kimura T, Tanaka N, Satoh K, Matsumoto S,Ninomiya M, et al. An assessment of the feasibility of sentinel lymph node-guided surgery for gastric cancer.Gastric Cancer. 2004; 7(3): 149-53.
29. Song X, Wang L, Chen W, Pan T, Zhu H, Xu J, et al.Lymphatic mapping and sentinel node biopsy in gastric cancer. Am J Surg. 2004; 187(2): 270-3.
30. Lee SE, Lee JH, Ryu KW, Cho SJ, Lee JY, Kim CG, et al. Sentinel node mapping and skip metastases in patients with early gastric cancer. Ann Surg Oncol. 2009; 16(3):603-8.
31. Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T,Nonomura A. Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg. 2003; 90(2):178-82.
32. Ishizaki M, Kurita A, Kubo Y, Takashima S, Nishina T,Nishimura E. Evaluation of sentinel node identification with isosulfan blue in gastric cancer. Eur J Surg Oncol.2006; 32(2): 191-6.
33. Arigami T, Natsugoe S, Uenosono Y, Mataki Y, Ehi K Higashi H, et al. Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction. Ann Surg. 2006; 243(3): 341-7.
34. Hayashi H, Ochiai T, Mori M, Karube T, Suzuki T, Gunji Y, et al. Sentinel lymph node mapping for gastric cancer using a dual procedure with dye- and gamma probeguided techniques. J Am Coll Surg. 2003; 196(1): 68-74.
35. Wang LB, Shen JG, Dong LF, Xu CY, Chen WJ, Xie SD,et al. Laparoscopic local resection based on sentinel node evaluation for early gastric cancer: a preliminary report. J Gastrointest Surg. 2008; 12(8): 1359-63.
36. Simsa J, Hoch J, Leffler J, Schwarz J, Pospisil R,Vajtrova R. Sentinel node biopsy in gastric cancer:preliminary results. Acta Chir Belg. 2003; 103(3): 270-3.
37. Lee JH, Ryu KW, Nam BH, Kook MC, Cho SJ, Lee JY,et al. Factors associated with detection failure and falsenegative sentinel node biopsy findings in gastric cancer:results of prospective single center trials. J Surg Oncol.2009; 99(3): 137-42.
38. Miyashiro I, Hiratsuka M, Kishi K, Takachi K, Yano M,Takenaka A, et al. Intraoperative diagnosis using sentinel node biopsy with indocyanine green dye in gastric cancer surgery: an institutional trial by experienced surgeons.Ann Surg Oncol. 2013; 20(2): 542-6.
39. Ajisaka H, Miwa K. Micrometastases in sentinel nodes of gastric cancer. Br J Cancer. 2003; 89(4): 676-80.
40. Lee YJ, Ha WS, Park ST, Choi SK, Hong SC, Park JW.Which biopsy method is more suitable between a basin dissection and pick-up biopsy for sentinel nodes in laparoscopic sentinel-node navigation surgery (LSNNS) for gastric cancer? J Laparoendosc Adv Surg Tech A.2008; 18(3): 357-63.
41. Kim MC, Kim HH, Jung GJ, Lee JH, Choi SR, Kang DY,et al. Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer. Ann Surg. 2004;239(3): 383-7.
42. Yasuda K, Inomata M, Fujii K, Shiraishi N, Adachi Y,Kitano S. Superficially spreading cancer of the stomach.Ann Surg Oncol. 2002; 9(2): 192-6.
43. Isozaki H, Okajima K, Fujii K. Histological evaluation of lymph node metastasis on serial sectioning in gastric cancer with radical lymphadenectomy.Hepatogastroenterology. 1997; 44(16): 1133-6.
44. Gretschel S, Bembenek A, Hunerbein M, Dresel S,Schneider W, Schlag PM. Efficacy of different technical procedures for sentinel lymph node biopsy in gastric cancer staging. Ann Surg Oncol. 2007; 14(7): 2028-35.
45. Osaka H, Yashiro M, Sawada T, Katsuragi K, Hirakawa K. Is a lymph node detected by the dye-guided method a true sentinel node in gastric cancer? Clin Cancer Res.2004; 10(20): 6912-8.
46. Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer. 2011; 14(2): 113-23.
47. Cunningham D, Allum WH, Stenning SP, Thompson JN,Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006; 355(1):11-20
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| Issue | Vol 3 No 1-2 (2016) | |
| Section | Original Article(s) | |
| Keywords | ||
| Biopsy Gastric cancer Metastasis Patent blue Sentinel lymph node | ||
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How to Cite
1.
Shirzadi A, Mahmoodzadeh H. Evaluation of a Sentinel Lymph Node Biopsy with Patent Blue in Locally Advanced Gastric Cancer. AJS. 2016;3(1-2):24-29.
