Sentinel Node Navigation Surgery in Early-Stage Esophageal Cancer

Takeuchi, Hiroya; Kawakubo, Hirofumi; Takeda, Flávio Roberto; Omori, Tai; Kitagawa, Yuko

doi:10.5761/atcs.ra.12.01951

Cited by 20 publications

(17 citation statements)

References 45 publications

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“…These efforts have not yet led to a reproducible technique for intraoperative in-situ SLN identification 10–12 . The frequent requirement for an open procedure with back table dissection of the esophagectomy specimen, along with exposure of patients and staff to radioactive tracers have hindered widespread clinical translation.…”

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of near-infrared image-guided lymphatic mapping of regional lymph nodes in esophageal cancer

Hachey

Gilmore

Armstrong

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Objective To assess safety and feasibility of an intraoperative, minimally invasive NIR image-guided approach to lymphatic mapping in esophageal cancer patients. Although local lymph nodes (LNs) are removed with the esophageal specimen, no techniques are available to identify the regional LNs (separate from the esophagus) during esophagectomy. We hypothesize that NIR imaging can identify regional LNs with potential to improve staging and the extent of lymphadenectomy (LAD). Methods Of the 10 patients enrolled, nine had resectable esophageal adenocarcinoma and underwent NIR mapping following peritumoral, submucosal injection of Indocyanine Green (ICG) alone or pre-mixed in human serum albumin (ICG:HSA) prior to resection. NIR imaging was performed in situ and ex vivo. Results Intraoperative NIR imaging demonstrated NIR signal at all tumors and in 2–6 NIR+ regional LNs in six of the patients. NIR+ LNs were not identified in 4 cases: one occult stage IV patient, for which further imaging was not performed and was thus excluded from analysis, and 3 cases in which ICG was used without HSA. Identification of local LNs on the esophagus was obscured by peritumoral background. Importantly, pathologic status of NIR+ regional LNs reflected overall regional nodal status. Conclusions NIR lymphatic mapping is safe and feasible in esophageal cancer and can identify regional LNs when ICG:HSA is used. Although future work is needed to improve background signal and local LN identification, intraoperative detection of regional NIR+ LNs allows in-depth histologic analysis of LN basins not commonly scrutinized as part of the specimen and may improve detection of occult nodal disease.

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Section: Introductionmentioning

confidence: 99%

Safety and feasibility of near-infrared image-guided lymphatic mapping of regional lymph nodes in esophageal cancer

Hachey

Gilmore

Armstrong

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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“…The identification rates and the sensitivity were promising in patients with T1 or T2 tumors without clinical lymph node involvement 44,45. Further prospective trials with larger numbers of patients are required to confirm these findings.…”

Section: The Role Of Lymph Node Mapping In Cancer Managementmentioning

confidence: 80%

Mapping lymph nodes in cancer management – role of 99mTc-tilmanocept injection

Tausch¹,

Baege²,

Rageth³

2014

OTT

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Two decades ago, lymphatic mapping of sentinel lymph nodes (SLN) was introduced into surgical cancer management and was termed sentinel node navigated surgery. Although this technique is now routinely performed in the management of breast cancer and malignant melanoma, it is still under investigation for use in other cancers. The radioisotope technetium (99mTc) and vital blue dyes are among the most widely used enhancers for SLN mapping, although near-infrared fluorescence imaging of indocyanine green is also becoming more commonly used. 99mTc-tilmanocept is a new synthetic radioisotope with a relatively small molecular size that was specifically developed for lymphatic mapping. Because of its small size, 99mTc-tilmanocept quickly migrates from its site of injection and rapidly accumulates in the SLN. The mannose moieties of 99mTc-tilmanosept facilitate its binding to mannose receptors (CD206) expressed in reticuloendothelial cells of the SLN. This binding prevents transit to second-echelon lymph nodes. In Phase III trials of breast cancer and malignant melanoma, and Phase II trials of other malignancies, 99mTc-tilmanocept had superior identification rates and sensitivity compared with blue dye. Trials comparing 99mTc-tilmanocept with other 99mTc-based agents are required before it can be routinely used in clinical settings.

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“…That is why the efforts of mapping SN are made. Mapping SN and its immunohistochemical and/or molecular evaluation can not only have an impact on the detection outcome correction of micrometastases but also on the limitation of lymphadenectomy in patients in the early stage of esophageal cancer [27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Lymph node micrometastases of adenocarcinoma located in gastroesophagal junction

Włodarczyk¹,

Mueller²,

Włodarczyk³

2013

pjp

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Background:The aim of this study was to evaluate the presence of micrometastases (MM) and tumor cell microinvolvement (TCM) in regional lymph nodes of patients with gastroesophageal junction adenocarcinoma. Material and methods: 61 patients with adenocarcinoma (stage N0) were included in this study. Lymph nodes removed during surgery were examined using mixed monoclonal antibodies against pan-cytokeratins (AE1/AE3). Micrometastases was defined as single neoplastic cells or infiltration with diameter below 0.5 mm but not involving the interstitium. Results: Micrometastases were found in 2 cases with adenocarcinoma type I and 4 cases with type III. Tumor cell microinvolvement was found in 2 cases of either adenocarcinoma type I or type III (according to Siewert's classification). Presence of MM did not influence survival rate. Conclusions: Despite no influence of MM presence on survival rate, MM came from adenocarcinoma type III more frequently. The presence of MM proved lack of homogeneity in the group of N0 stage and makes evaluation advantageous.

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Sentinel Node Navigation Surgery in Early-Stage Esophageal Cancer

Cited by 20 publications

References 45 publications

Safety and feasibility of near-infrared image-guided lymphatic mapping of regional lymph nodes in esophageal cancer

Safety and feasibility of near-infrared image-guided lymphatic mapping of regional lymph nodes in esophageal cancer

Mapping lymph nodes in cancer management – role of 99mTc-tilmanocept injection

Lymph node micrometastases of adenocarcinoma located in gastroesophagal junction

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Sentinel Node Navigation Surgery in Early-Stage Esophageal Cancer

Cited by 20 publications

References 45 publications

Safety and feasibility of near-infrared image-guided lymphatic mapping of regional lymph nodes in esophageal cancer

Safety and feasibility of near-infrared image-guided lymphatic mapping of regional lymph nodes in esophageal cancer

Mapping lymph nodes in cancer management &ndash; role of 99mTc-tilmanocept injection

Lymph node micrometastases of adenocarcinoma located in gastroesophagal junction

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Mapping lymph nodes in cancer management – role of 99mTc-tilmanocept injection