Lymphatic Mapping for Gastric Adenocarcinoma

Abstract

The role of lymphadenectomy for gastric carcinoma has been debated for decades. Lymphatic mapping has revolutionized the treatment of melanoma and breast cancer. However, its potential utility in guiding lymphadenectomy for gastric carcinoma is unknown. Therefore we initiated a trial to investigate lymphatic mapping for gastric carcinoma at Wake Forest University Baptist Medical Center. Lymphatic mapping for gastric carcinoma was attempted in 14 cases of gastric carcinoma. Mapping was performed by perilesional injection of isosulfan blue and the first node in the draining basin was harvested and sent fresh to pathology. Sentinel lymph nodes (SLNs) were evaluated by hematoxylin and eosin (H&E) staining. Immunohistochemical analysis was performed on all SLNs that were found to be negative on initial histologic studies. Radical gastrectomy with celiac node dissection was performed in all cases. SLNs were identified in 14 cases. In one case the technique was abandoned because of bulk nodal disease. The average number of SLNs found in each case was 2.8 with a range of one to five. Eight of 14 patients were found to have SLNs positive for metastatic carcinoma. In seven of these patients pathologic analysis of the final resection specimen confirmed the presence of nodal disease. In one case carcinoma was found in a SLN on touch preparation and no nodal disease was noted in the resection specimen. Immunohistochemical studies performed on SLNs found to be negative on initial H&E histologic analysis failed to reveal the presence of carcinoma. The overall sensitivity and specificity were found to be 72.7 and 75 per cent, respectively. Lymphatic mapping is technically possible in the setting of gastric carcinoma and SLNs can be successfully identified in the majority of cases. Upstaging occurred in one case which may have ramifications for adjuvant therapy. SLN positivity accurately predicts the presence of additional nodal disease beyond the SLN in the final resection specimen (positive predictive value 89%). However, SLN negativity does not definitively prove that the remaining nodal basin is free of disease (negative predictive value 50%). Lymphatic mapping for gastric carcinoma is a promising technique worthy of further investigation.

Interim Results of Sentinel Node Biopsy during Laparoscopic Gastrectomy: Possible Role in Function‐Preserving Surgery for Early Cancer

“…To select the optimal tracer, several reports insist on the usefulness of a single tracer, such as dye (patent blue, isosulfan blue, indocyanine blue) or radioactive tracers [10][11][12][13][14][15][16][17] ; however, lymphatic mapping with dye injection alone or a radioactive tracer alone showed comparatively low sensitivity or specificity. 18,19 Using a dual-tracer method as the optimal procedure, the radioguided method allowed us to confirm the complete harvest of SNs by gamma probing, and the dye procedure enabled us to perform real-time observation of the lymphatic vessels.…”

Laparoscopic Lymphatic Mapping and Sentinel Node Biopsies for Early‐stage Gastric Cancer: The Cause of False Negativity

“…Many clinical studies on the use of sentinel node (SN) biopsies in patients with breast cancer, cervical cancer, cancer of the vulva, and mouth cancer are now in progress [1]. However, the few reports on SNs in gastric cancer patients have just reached the feasibility study stage [2][3][4][5][6][7][8][9][10].…”

Management of Gastric Cancer

“…Patent blue violet (Hayashi et al, 2003;Karube et al, 2004;Simsa et al, 2003), isosulfan blue (Hundley et al, 2002;Isozaki et al, 2004;Osaka et al, 2004;Ryu et al, 2003;Song t al., 2004) and indocyanine green (ICG) Ichikura et al, 2002;Nimura et al, 2004) have been used as vital dye tracers for the detection of SNs in gastric carcinoma. The detection rates of SNs were 72-96%, 91-100% and 99-100%, respectively.…”

“…Development of a convenient and sensitive method useful for the detection of SNs will enable surgeons to rationally determine the extent of LN dissection and to perform minimally invasive surgery (Krag et al, 1998;Morton, 1992;van der Veen et al, 1994;Veronesi et al, 1997). Several methods have been developed to detect SNs using radioactive materials or vital dyes, such as patent blue violet, isosulfan blue and indocyanine green in gastric carcinoma (Hayashi et al, 2003;Hundley et al, 2002;Ichikura et al, 2002;Isozaki et al, 2004;Karube et al, 2004;Kim, M.C. et al, 2004;Kitagawa & Kitajima, 2002;Nimura et al, 2004;Osaka et al, 2004;Ryu et al, 2003;Simsa et al, 2003;Song et al, 2004;Tanaka et al, 2004).…”