J Korean Surg Soc.  2003 Sep;65(3):223-227.

Sentinel Node Biopsy in Gastric Cancer

Affiliations
  • 1Department of Surgery, Dong-A University College of Medicine, Busan, Korea. mckim@donga.ac.kr
  • 2Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
  • 3Department of Nuclear Medicine, Dong-A University College of Medicine, Busan, Korea.
  • 4Department of Pathology, Dong-A University College of Medicine, Busan, Korea.

Abstract

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 (99m)Tc 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+ alpha). 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.

Keyword

Sentinel lymph node biopsy; Stomach neoplasm; Radioisotope; Lymphatic metastasis

MeSH Terms

Biopsy*
Gamma Cameras
Gastrectomy
Head
Humans
Immunohistochemistry
Keratins
Lymph Nodes
Lymphatic Metastasis
Lymphoscintigraphy
Neoplasm Metastasis
Neoplasm Micrometastasis
Paraffin
Sensitivity and Specificity
Sentinel Lymph Node Biopsy
Stomach Neoplasms*
Keratins
Paraffin
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