Detection of micrometastases in sentinel node navigation surgery for gastric cancer

Yanagita, Shigehiro; Natsugoe, Shoji; Uenosono, Yoshikazu; Arigami, Takaaki; Arima, Hideo; Kozono, Tsutomu; Funasako, Yawara; Ehi, Katsuhiko; Nakajo, Akihiro; Ishigami, Sumiya; Aikou, Takashi

doi:10.1016/j.suronc.2008.04.008

Cited by 32 publications

(30 citation statements)

References 56 publications

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“…Furthermore, Kumagai et al [30] reported that the sensitivity and specificity of the one-step nucleic acid amplification assay compared with histological examination in detecting cytokeratin 19 mRNA were 83.3 and 95.9 %, respectively. Recent developments in molecular biological techniques have reduced the detection time to 30-40 min [31]. These molecular biological methods have dramatically improved the sensitivity of SN metastasis in the intraoperative diagnosis but remain incomplete.…”

Section: Intraoperative Diagnosis Of Snsmentioning

confidence: 99%

A new stage of sentinel node navigation surgery in early gastric cancer

et al. 2014

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Sentinel node (SN) navigation surgery is expected to realize organ-and function-preserving surgery with SN mapping, and has been applied in operations for breast cancer and melanoma. But there has been no definite evidence for the SN concept in gastric cancer. A prospective multicenter trial to confirm the SN concept for gastric cancer conducted by the Japan Society of Sentinel Node Navigation Surgery reported that the SN detection rate, sensitivity of positive SNs, and accuracy of nodal status are 97.5 % (387/397), 93 % (53/57), and 99 % (383/ 387), respectively. A detailed analysis of the trial suggested that strictly the ''lymphatic basin concept'' rather than the ''SN concept'' was confirmed in early gastric cancer. The Japan Society of Sentinel Node Navigation Surgery started a new trial of function-preserving gastrectomy with lymphatic basin dissection (LBD) for early gastric cancer without metastasis in SNs on the basis of this promising outcome of the trial. It is supposed that LBD guarantees curability in SN navigation surgery for early gastric cancer. Full-thickness resection or endoscopic submucosal dissection in combination with laparoscopic LBD will soon be a new treatment option for early gastric cancer.

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Section: Intraoperative Diagnosis Of Snsmentioning

confidence: 99%

A new stage of sentinel node navigation surgery in early gastric cancer

et al. 2014

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“…At present, SNs are examined using frozen sections, and hematoxylin-eosin (HE) staining is performed for a few sections. In early gastric cancer, isolated tumor cells (ITCs) are seen, or micrometastasis (MM) involving lymph nodes is observed infrequently [11], and these are difficult to diagnose based on frozen sections and HE staining in the limited time available. Detailed pathological examination, such as multisectioning or immunohistochemical (IHC) staining, is necessary for the accurate diagnosis of these metastatic nodes.…”

Section: Introductionmentioning

confidence: 99%

Auxiliary diagnosis of lymph node metastasis in early gastric cancer using quantitative evaluation of sentinel node radioactivity

et al. 2015

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Background Sentinel node (SN) mapping using dye and radioisotope (RI) tracer has been reported to be feasible in cases of early gastric cancer. Because accurate diagnosis of micrometastasis is sometimes difficult in the limited time available during surgery, a faster and simpler method of improving the intraoperative diagnostic precision of lymph node metastasis is needed. The amount of tracer deposited in an SN can be determined from its radioactivity; however, the significance of the RI count has not been fully discussed. We investigated the clinical impact of the RI count when used as an adjunct to conventional lymph node dissection when diagnosing lymphatic metastasis in cases of early gastric cancer. Methods From 2008 to 2009, patients with clinically diagnosed T1N0M0 gastric cancers who underwent gastrectomy and SN mapping were enrolled. SNs were examined by intraoperative and postoperative pathology. The RI count was measured for each SN with a handheld gamma probe; the correlation between nodal metastasis and the RI count was assessed. Results A total of 308 SNs were harvested from 72 patients. Patients with SN metastasis had significantly higher total RI counts than those without SN metastasis (p = 0.007). Among cases with SN metastasis, RI counts were also significantly elevated in metastasis-positive nodes, stations, and basins. In these cases, the most of SNs having the highest RI count in each case had metastasis including isolated tumor cells. Conclusion In early gastric cancer patients, a high RI count from an SN was correlated with lymph node metastasis. Therefore, RI counting may aid efficient pathological diagnosis and focused lymph node dissection.

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“…However, other MM and ITC definitions were described: Nakajo et al [22] defined MM as clusters of tumor cells with stromal reaction; Lee et al [2] as tumor deposits in LN with histological evidence of malignant activity, such as gland formation or stromal reaction (even if they were smaller than 0.2 mm), and Cai et al [23] as the presence of one or more aggregates or clusters of more than 2 tumor cells. The most recent studies [4,6,24,25,26,27,28,29,30] used the UICC definition of OTC in a standardized manner. …”

Section: Resultsmentioning

confidence: 99%

“…Yanagita and colleagues [25,26,27] concluded that, although RT-PCR is a nonmorphological diagnostic method, a positive LN with this method may in fact indicate the presence of nodal metastases. …”

Section: Resultsmentioning

confidence: 99%

Occult Tumor Cells in Lymph Nodes of Patients with Gastric Cancer: A Systematic Review on Their Prevalence and Predictive Role

Tavares

Monteiro‐Soares²,

Viveiros³

et al. 2015

Oncology

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Background and Aims: The presence of lymph node (LN) metastasis is a key prognostic factor for gastric adenocarcinoma. However, even among patients without LN metastasis (N0), recurrence may occur. In some of these cases, occult tumor cells (OTC) are thought to play an important role. We aimed to determine the prevalence of OTC and its clinical relevance. Methods: We conducted a systematic review of studies in English published until September 2013 that addressed OTC prevalence and/or its clinical relevance. The studies were retrieved from the MEDLINE database. Results: We included 42 studies. The most frequently used methods for detecting OTC were immunohistochemical examination (IHC) and/or polymerase chain reaction (PCR) with a wide range of markers. Using IHC for OTC detection, in patients and in LN, the prevalence varied from 9 to 88% and 0.4 to 42%, respectively. With PCR, it ranged from 17 to 46% in patients, and from 3 to 33% in LN. In the studies assessing the predictive role of OTC in gastric cancer recurrence (n = 24), 8 studies found no statistical association, while 18 concluded that OTC presence was associated with poorer prognosis. However, only 6 studies presented a significantly different 5-year survival rate between patients with and without LN micrometastasis. Conclusions: OTC seems to occur in gastric cancer patients with a variable prevalence, depending on the definition, methods and setting. The majority of the retrieved studies (75%) evaluating the predictive role of OTC conclude that its presence is associated with a worse prognosis.

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Detection of micrometastases in sentinel node navigation surgery for gastric cancer

Cited by 32 publications

References 56 publications

A new stage of sentinel node navigation surgery in early gastric cancer

A new stage of sentinel node navigation surgery in early gastric cancer

Auxiliary diagnosis of lymph node metastasis in early gastric cancer using quantitative evaluation of sentinel node radioactivity

Occult Tumor Cells in Lymph Nodes of Patients with Gastric Cancer: A Systematic Review on Their Prevalence and Predictive Role

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