Regional Lymphatic Metastases of Carcinoma of the Stomach

Coller, Frederick A.; Kay, Earle B.; McINTYRE, Robert S.

doi:10.1001/archsurg.1941.01210170015002

Cited by 95 publications

(24 citation statements)

References 2 publications

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“…The lymphatic drainage of the breast is relatively straightforward: most of the lymphatic drainage will go to the axilla. The lymphatic system of the stomach, however, is much more complex, as the gastric wall is supplied with a very rich submucosal lymphatic network that freely communicates with other equally complex intermuscular and subserosal lymphatic networks [37,38]. This rich lymphatic network, dilution and widespread distribution of the dye and radiocolloid, and multi-directional lymphatic flow should be considered in order to minimize false-negative cases [22].…”

Section: Implications Of the False-negative Ratementioning

confidence: 99%

What is the accuracy of sentinel lymph node biopsy for gastric cancer? A systematic review

et al. 2012

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Background In gastric cancer, the utility of sentinel lymph node (SLN) biopsy has not been established. SLN may be a good predictor of the pathological status of other lymph nodes and thus the necessity for more extensive surgery or lymph node dissection. We aimed to identify and synthesize findings on the performance of SLN biopsies in gastric cancer. Methods Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from 1998 to 2009. Titles and abstracts were independently rated for relevance by a minimum of two reviewers. Techniques, detection rates, accuracy, sensitivity, specificity, and false-negative rates (FNRs) were analyzed. Analysis was performed based on the FNR. Results Twenty-six articles met our inclusion criteria. SLN detection using the dye method (DM) was reviewed in 18 studies, the radiocolloid method (RM) was used in 12 studies, and both dye and radiocolloid methods (DUAL) were used in 5 studies. The DM had an overall calculated FNR of 34.7% (95% confidence interval [CI] 21.2, 48.1). The RM had an overall calculated FNR of 18.5% (95% CI 9.1, 28.0). DUAL had an overall calculated FNR of 13.1% (95% CI -0.9, 27.2). Conclusion Application of the SLN technique may be practical for early gastric cancer. The use of DUAL for identifying SLN may yield a lower FNR than either method alone, although statistical significance was not met.

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Section: Implications Of the False-negative Ratementioning

confidence: 99%

What is the accuracy of sentinel lymph node biopsy for gastric cancer? A systematic review

et al. 2012

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“…Considering the direction of lymphatic flow, lymphatics from upperthird tumors drain to the proximal lesser curvature nodes and then to the nodes alongside the root of the LGA (no. 7), rather than to the distal lesser curvature nodes [13]. In 2011, the Japanese Gastric Cancer Association (JGCA) redefined the no.…”

Section: Introductionmentioning

confidence: 99%

Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer

et al. 2016

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Background Proximal gastrectomy has been introduced for early gastric cancer located in the upper third of the stomach, but expansion of its indication to advanced tumors has not been generally accepted in terms of lesser curvature lymph node dissection. Methods We reviewed the medical records of 385 patients with tumors in the upper third of the stomach, and the incidence of metastasis and the therapeutic index related to the proximal (no. 3a) and distal (no. 3b) lymph nodes of the lesser curvature were analyzed and compared with those of tumors in the middle third (n = 1093) and lower third (n = 922) of the stomach. Results The no. 3a rate of metastasis from advanced tumors in the upper third of the stomach was significantly higher than that from tumors in the middle third or lower third of the stomach. The no. 3b metastasis rate did not show any significant differences between the three locations, but the therapeutic index of no. 3b lymph nodes in the upper third of the stomach (1.7) was far lower than that in the middle third (7.1) or lower third (7.0). Further, the rate of metastasis from tumors with the distal border ending in the upper third of the stomach (2.2 %) was significantly (P \ 0.0001) lower than that from tumors located in the upper third of the stomach but extending to the middle third (19.6 %), as well as from tumors located in middle third (17.1 %) or lower third (19.6 %), with the therapeutic index being only 1.1. The four no.-3b-positive tumors all measured more than 40 mm, and included one T3 tumor and three T4 tumors. Conclusion Proximal gastrectomy with exclusion of no. 3b lymphadenectomy could be indicated for at least T2 tumors measuring less than 40 mm localized in the upper third of the stomach.

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“…The lymphatic basins with lymphatic vessels and lymph nodes stained with our blue dye injection technique can also be classified into five areas: right and left gastric artery, right and left gastroepiploic artery, and posterior gastric artery (Coller et al, 1941). In this study, non-SNs were evaluated by serial sectioning and immunostaining in addition to conventional histology, and metastatic non-SNs were detected in two patients with metastatic SNs detected by conventional histology and in one patient with micrometastatic SNs seen on RT -PCR and Southern blot assay.…”

Section: Discussionmentioning

confidence: 99%

“…Lymphatic basins were classified into five directions: right and left gastric artery, right and left gastroepiploic artery, and posterior gastric artery (Coller et al, 1941). The relationship between the location of the gastric carcinoma and the number of SNs detected in each lymphatic basin is shown in Table 1.…”

Section: Surgical Specimens and Blood Preparationmentioning

confidence: 99%

Micrometastases in sentinel nodes of gastric cancer

Ajisaka

Miwa

2003

Br J Cancer

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The sentinel node (SN) is the first lymph node in the lymphatic basin to be affected by metastasis from the primary tumour and is used to predict the status of the remaining nodes in the basin. We succeeded in detecting SNs of clinically early gastric cancers by intraoperative injection of a blue dye around the tumour. In the study presented here, multiple-marker reverse transcriptionpolymerase chain reaction (RT -PCR) was used to detect micrometastases in SNs and results were compared with those obtained with conventional histology. Expressions of cytokeratin-18 (CK-18), carcinoembryonic antigen (CEA), human telomerase reverse transcriptase (hTRT) and MUC-1 in SNs were determined by RT -PCR and Southern blot assay. Of the 213 SNs obtained from 35 cases of gastric cancer, eight nodes (3.8%) from five patients contained metastases that could be identified by conventional histology. However, CK-18 mRNA was expressed in 15 (7.0%), CEA in 12 (5.6%), hTRT in 10 (4.7%), and MUC-1 in 12 (5.6%) nodes, with at least one mRNA marker expressed in 25 nodes (11.7%) obtained from six patients. In the five patients with nodal metastases identified by conventional histology, two had metastases in both SNs and non-SNs. And, in the 30 patients without nodal metastases identified by conventional histology, one patient with micrometastases in the SNs identified by RT -PCR and Southern blot assay also had metastases in non-SNs as identified by serial sectioning and immunostaining of CK-18. All additional metastases were detected in non-SNs located in the same lymphatic basin as the previously detected SNs. This suggests that lymph node dissection of early-stage gastric cancer in the lymphatic basin may be mandatory even for patients without histologically detectable metastases in SNs. British Journal of Cancer (2003) Lymph node metastasis is one of the most important determinants of whether minimally invasive surgery for early gastric cancer is appropriate, since lymph node dissection generally is considered unnecessary for early gastric cancer without nodal metastasis. Endoscopic mucosal resection or minimally invasive surgery without lymphadenectomy has recently been advocated for early gastric cancer without nodal metastasis. Predicting the absence of nodal metastasis is usually based on indirect evidence, by comparing the primary tumour in a particular case with those in other cases (Makuuchi et al, 1999). We succeeded in identifying sentinel nodes (SNs) in gastric cancer by intraoperative injection of blue dye around the tumour (Miwa et al, 2003). The SN is the first lymph node in the lymphatic basin to be affected by metastasis from the primary tumour and is used to predict the status of lymph nodes in the rest of the lymphatic basin (Morton et al, 1992). Metastases in the SNs are determined by intraoperative pathology, but if there is a discrepancy between the intraoperative diagnosis and postoperative diagnosis detailed examination results, a definitive operation cannot be performed only on the basis of a sentinel node biop...

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Regional Lymphatic Metastases of Carcinoma of the Stomach

Cited by 95 publications

References 2 publications

What is the accuracy of sentinel lymph node biopsy for gastric cancer? A systematic review

What is the accuracy of sentinel lymph node biopsy for gastric cancer? A systematic review

Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer

Micrometastases in sentinel nodes of gastric cancer

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