What Is the Problem in Clinical Application of Sentinel Node Concept to Gastric Cancer Surgery?

Miyashiro, Isao

doi:10.5230/jgc.2012.12.1.7

Cited by 34 publications

(19 citation statements)

References 25 publications

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“…Moreover, a prospective multicenter clinical trial of a novel semi-automated molecular-based rapid diagnostic method for LN metastases using one-step nucleic acid amplification (OSNA) indicated that the method is feasible for intraoperative detection of LN metastases in patients with gastric cancer (Kumagai et al, submitted). Such new technology could overcome the difficulties of clinical application of the SN technique [26]. …”

Section: Discussionmentioning

confidence: 99%

High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302

et al. 2013

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Background To evaluate the feasibility and accuracy of diagnosis using sentinel node (SN) biopsy in T1 gastric cancer, a multicenter trial was conducted by the Japan Clinical Oncology Group (JCOG). Methods Sentinel node biopsy with indocyanine green (ICG) was performed in patients with T1 gastric cancer. Green-stained nodes (GNs), representing SNs, were removed first, and gastrectomy with lymphadenectomy was then performed. GNs in one plane (with the largest dimension) were histologically examined intraoperatively by frozen section with hematoxylin and eosin (H&E) stain. All harvested lymph nodes (GNs and non-GNs) were histologically examined by paraffin section after surgery. The primary endpoint was to determine the proportion of false negatives, which was defined as the number of patients with negative GNs by frozen section divided by those with positive GNs and/or positive non-GNs by paraffin section. The sample size was set at 1,550, based on the expected and threshold value as 5 and 10 % in the proportion of false negatives. Results Accrual was suspended when 440 patients were enrolled because the proportion of false negatives was high. In the primary analysis, the proportion of false negatives was 46 % (13/28) after a learning period with 5 patients for each institution. Seven of 13 patients had nodal metastases outside the lymphatic basin. False negatives remained at 14 % (4/28) even by examining additional sections of GNs by paraffin section. Conclusions The proportion of false negatives was much higher than expected. Intraoperative histological 123Gastric Cancer (2014( ) 17:316-323 DOI 10.1007 examination using only one plane is not an appropriate method for clinical application of SN biopsy in gastric cancer surgery.

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Section: Discussionmentioning

confidence: 99%

High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302

et al. 2013

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“…It has not been elucidated why this case only metastasized to the GNs; however, this suggests that it is crucial to limit SNNS to early gastric cancer. There has been some debate over the actual procedures for the clinical application of SNNS in gastric cancer, including the type of tracer to be used, the injection site, how to detect and harvest SNs and how to detect metastatic SNs (16). As regards the detection of metastatic SNs, researchers tend to focus on diagnostic methods, such as molecular techniques, rather than frozen section diagnoses with hematoxylin and eosin (H&E), which tend to be inaccurate.…”

Section: Discussionmentioning

confidence: 99%

Preferentially examined sentinel nodes for sentinel node navigation surgery in gastric cancer

Yaguchi

Tsujimoto

Hiraki

et al. 2015

Molecular and Clinical Oncology

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Abstract. The intraoperative examination of the sentinel nodes (SNs) is crucial for correctly performing SN navigation surgery (SNNS). Frozen-section diagnosis is ordinarily used; however, when several SNs are being assessed in gastric cancer, which has numerous regional lymph nodes, it is difficult to examine them all correctly within the short duration of surgery. In the present study, we aimed to determine the SNs that should be preferentially examined during SNNS in gastric cancer. A total of 824 SNs were examined in 113 patients with clinically determined T1-2 gastric cancer and no apparent lymph node metastasis. We focused on the accumulation of tracers expressed by hot nodes (HNs) using the radioisotope (RI) method and green nodes (GNs) using the dye-guided method and measured the radioactivity count of the HNs (RI count). We compared these parameters between 35 metastatic and 789 non-metastatic SNs. The percentage of metastasis-positive SNs that were radioactively 'hot' and dyed green was higher compared with that of the negative SNs (89 vs. 43%, respectively; P<0.01). The RI counts of the metastasis-positive SNs were higher compared with those of the negative SNs [median (range): 361 (0-10,670) vs. 53 (0-9,931), respectively; P<0.01]. The area under the receiver operating characteristic curve of the RI count was 0.69 (95% CI: 0.60-0.78). Therefore, when assessing several SNs, those with higher RI counts (HNs and GNs) should be preferentially examined. Further accumulation of cases is required to establish the cut-off value for the diagnosis of metastasis based on the RI count.

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“…In contrast, the Japan Clinical Oncology Group (JCOG) also conducted a multicenter prospective trial of SN biopsy for cT1N0 gastric cancer [30]. The JCOG 0302 study was designed to assess the feasibility and accuracy of SN biopsy by the dye-guided method with intraoperative subserosal direct injection of ICG.…”

Section: Results Of Intraoperative Sn Mapping For Gastric Cancermentioning

confidence: 99%

Sentinel Node Navigation Surgery in Patients with Early Gastric Cancer

Takeuchi

Kitagawa²

2013

Dig Surg

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Clinical application of sentinel node (SN) mapping in patients with early gastric cancer has been a controversial issue for years. However, a recent meta-analysis and a prospective multicenter trial of SN mapping for early gastric cancer have shown acceptable SN detection rates and accuracy of determination of lymph node status. A dual-tracer method that utilizes radioactive colloids and blue dyes is currently considered the most reliable method for the stable detection of SNs in patients with early gastric cancer. However, new technologies such as indocyanine green infrared or fluorescence imaging might revolutionize the SN mapping procedures in gastric cancer. For early-stage gastric cancer such as cT1N0, for which a better prognosis can be potentially achieved through conventional surgical approaches, the establishment of individualized, minimally invasive treatments that may retain the patients' quality of life should be the next surgical challenge. Although there are many unresolved technical issues, laparoscopic SN biopsy with laparoscopic minimized gastrectomy or endoscopic mucosal resection/endoscopic submucosal dissection could be a promising strategy to achieve this goal.

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What Is the Problem in Clinical Application of Sentinel Node Concept to Gastric Cancer Surgery?

Cited by 34 publications

References 25 publications

High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302

High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302

Preferentially examined sentinel nodes for sentinel node navigation surgery in gastric cancer

Sentinel Node Navigation Surgery in Patients with Early Gastric Cancer

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