Kim Min-Chan, Kim Hyung-Ho, Jung Ghap-Joong, Lee Jong-Hun, Choi Seok-Ryeol, Kang Do-Young, Roh Mee-Sook, Jeong Jin-Sook
Department of Surgery, Dong-A University College of Medicine, Busan, South Korea.
Ann Surg. 2004 Mar;239(3):383-7. doi: 10.1097/01.sla.0000114227.70480.14.
The aim of this study was to determine the feasibility of sentinel lymph node (SLN) biopsy in patients with gastric cancer for the assessment of regional lymph node status.
SLN is the first draining node from the primary lesion, and it is the first site of lymph node metastasis in malignancy. SLN mapping and biopsy are of great significance in the determination of the extent of lymphadenectomy, allowing patients with gastric cancer to have a better quality of life without jeopardizing survival.
The SLN biopsy was performed in 46 consecutive patients having gastric cancer with a preoperative imaging stage of T1/T2, N0, or M0. Three hours prior to each operation, Tc tin colloid (2.0 mL, 1.0 mCi) was endoscopically injected into the gastric submucosa around the primary tumor. Subsequently, serial lymphoscintigraphy was performed using a dual-head gamma camera. After the SLN biopsy had been performed using a gamma probe, all patients underwent radical gastrectomy (D2 or D2+alpha). The SLN was cut and immediately frozen-sectioned. A paraffin block was then produced for permanent hematoxylin-eosin staining and immunohistochemistry (IHC).
SLNs were successfully identified in 43 of 46 patients (success rate, 93.5%). On average, 2 (range, 1-8) SLNs were identified per patient. The positive predictive value, negative predictive value, sensitivity, and specificity of SLN biopsy were 100% (11 of 11), 93.8% (30 of 32), 84.6% (11 of 13), and 100% (30 of 30), respectively. SLNs were located at the level I lymph nodes in 38 (88.4%), the level I+II nodes in 2 (4.7%), and the level II nodes in 3 (7.0%). No micrometastases of SLNs was found on IHC for cytokeratin.
SLN biopsy using a radioisotope in patients with gastric cancer is a technically feasible and accurate technique, and it is a minimally invasive approach in the assessment of patient nodal status.
本研究旨在确定前哨淋巴结（SLN）活检在胃癌患者中评估区域淋巴结状态的可行性。
SLN是原发灶的首个引流淋巴结，也是恶性肿瘤淋巴结转移的首个部位。SLN定位和活检在确定淋巴结清扫范围方面具有重要意义，可使胃癌患者在不危及生存的情况下获得更好的生活质量。
对46例术前影像学分期为T1/T2、N0或M0的连续胃癌患者进行SLN活检。每次手术前3小时，通过内镜将锝锡胶体（2.0 mL，1.0 mCi）注射到原发肿瘤周围的胃黏膜下层。随后，使用双头γ相机进行系列淋巴闪烁显像。使用γ探头进行SLN活检后，所有患者均接受根治性胃切除术（D2或D2+α）。将SLN切开并立即进行冰冻切片。然后制作石蜡块用于永久性苏木精-伊红染色和免疫组织化学（IHC）。
46例患者中有43例成功识别出SLN（成功率为93.5%）。每位患者平均识别出2个（范围为1-8个）SLN。SLN活检的阳性预测值、阴性预测值、敏感性和特异性分别为100%（11/11）、93.8%（30/32）、84.6%（11/13）和100%（30/30）。38个（88.4%）SLN位于Ⅰ级淋巴结，2个（4.7%）位于Ⅰ+Ⅱ级淋巴结，3个（7.0%）位于Ⅱ级淋巴结。免疫组织化学检测细胞角蛋白未发现SLN有微转移。
对胃癌患者使用放射性同位素进行SLN活检是一种技术上可行且准确的技术，是评估患者淋巴结状态的微创方法。
