Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A
Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Br J Surg. 2003 Feb;90(2):178-82. doi: 10.1002/bjs.4031.
Nodal status in gastric carcinoma is related not only to prognosis but also to the extent of nodal dissection. However, a method for accurate assessment of nodal status during operation has not been established. This study aimed to map the sentinel nodes of gastric carcinoma and to estimate the clinical usefulness of sentinel node biopsy.
Following laparotomy, a vital dye (0.2 ml 2 per cent patent blue) was injected through a gastroscope into the submucosal layer at four sites around a clinical T1 gastric carcinoma. The dye immediately appeared at the serosal surface and stained lymphatic vessels and nodes. The stained nodes were removed and examined by frozen sectioning.
The assay was successful in mapping the lymphatic basins in 203 (96.2 per cent) of 211 patients. The dye stained one or more metastatic nodes in 31 patients, but failed to indicate a metastatic node in four patients with a large involved node. Meticulous postoperative examination of all resected nodes in the standard paraffin slices revealed no new metastases. The accuracy of the assay was 98.0 per cent.
The method was accurate in predicting nodal status in patients with early-stage gastric carcinoma.
胃癌的淋巴结状态不仅与预后相关，还与淋巴结清扫范围有关。然而，尚未建立一种在手术期间准确评估淋巴结状态的方法。本研究旨在绘制胃癌前哨淋巴结图谱，并评估前哨淋巴结活检的临床实用性。
剖腹手术后，通过胃镜将活性染料（0.2毫升2%专利蓝）注射到临床T1期胃癌周围四个部位的黏膜下层。染料立即出现在浆膜表面，对淋巴管和淋巴结进行染色。切除染色的淋巴结并进行冰冻切片检查。
该检测方法成功绘制了211例患者中203例（96.2%）的淋巴引流区域。染料标记出31例患者中的一个或多个转移淋巴结，但在4例有大的受累淋巴结的患者中未能显示转移淋巴结。对标准石蜡切片中所有切除的淋巴结进行细致的术后检查，未发现新的转移灶。该检测方法的准确率为98.0%。
该方法在预测早期胃癌患者的淋巴结状态方面准确可靠。
