Gretschel S, Bembenek A, Ulmer Ch, Hünerbein M, Markwardt J, Schneider U, Schlag P M
Klinik für Chirurgie und Chirurgische Onkologie, Universitätsklinikum Chariteacute, Campus Berlin Buch, Robert-Rössle-Klinik im HELIOS Klinikum Berlin.
Chirurg. 2003 Feb;74(2):132-8. doi: 10.1007/s00104-002-0604-4.
Lymphatic mapping and the sentinel lymph node (SLN) concept has been validated in malignant melanoma and breast cancer.However, the application for other solid tumors is still controversial. One of the most promising approaches is selective lymph node staging in gastric cancer.The presented pilot study evaluated the feasibility of the radiocolloid technique in gastric cancer patients and its value in predicting a positive nodal status.
Fifteen patients with gastric cancer (u T(1-3)) underwent endoscopic submucosal injection of 0.4 ml 60 MBq (99m)Tc-Nanocis around the tumor 17 (+/-3) h prior to surgery. After laparotomy the activity of all 16 (JGCA) lymph node stations was measured by a handheld probe. All patients underwent standard gastrectomy with systematic D2 lymphadenectomy. After resection the site was scanned for residual activity. All sentinel lymph nodes (SLN's) were removed ex vivo from the resected specimen and processed for intensified histopathologic assessment including serial sections and immunohistochemistry.
In 14 of 15 patients at least one or more SLN's were obtained (93%), the median number of SLN's was 3 (1-5). Of the 14 patients, 9 revealed lymph node metastases. In eight of the nine patients the sentinel node(s) correctly predicted metastatic lymph node invasion. In five cases the lymph node station with positive sentinel node(s) was the only positive node station resulting in a sensitivity of 8/9 (89%). In one case immunohistochemical staining revealed micrometastases leading to an upstaging in 1/6 of the initially nodal-negative patients.
Lymphatic mapping and sentinel node biopsy using the radiocolloid technique is feasible in gastric cancer. Limited results indicate a correct prediction of the nodal status and the potential of upstaging.Further studies seem to be justified to evaluate the clinical impact of the method.
淋巴绘图和前哨淋巴结（SLN）概念已在恶性黑色素瘤和乳腺癌中得到验证。然而，其在其他实体瘤中的应用仍存在争议。最有前景的方法之一是胃癌的选择性淋巴结分期。本前瞻性研究评估了放射性胶体技术在胃癌患者中的可行性及其预测阳性淋巴结状态的价值。
15例胃癌患者（uT(1 - 3)）在手术前17（±3）小时接受内镜下在肿瘤周围黏膜下注射0.4 ml 60 MBq（99m）Tc - Nanocis。剖腹手术后，用手持探头测量所有16个（日本胃癌协会）淋巴结站的活性。所有患者均接受标准胃切除术及系统性D2淋巴结清扫术。切除后对手术部位进行扫描以检查残留活性。所有前哨淋巴结（SLN）均从切除标本中离体取出，并进行强化组织病理学评估，包括连续切片和免疫组织化学检查。
15例患者中有14例（93%）获得了至少一个或多个SLN，SLN的中位数为3（1 - 5）。在这14例患者中，9例发现有淋巴结转移。9例患者中有8例前哨淋巴结正确预测了转移性淋巴结侵犯。5例中，前哨淋巴结阳性的淋巴结站是唯一的阳性淋巴结站，敏感性为8/9（89%）。1例中免疫组织化学染色显示微转移，导致1/6最初淋巴结阴性的患者分期上调。
使用放射性胶体技术进行淋巴绘图和前哨淋巴结活检在胃癌中是可行的。有限的结果表明对淋巴结状态的预测正确，且有分期上调的可能。进一步的研究似乎有必要评估该方法的临床影响。
