Zulfikaroglu Baris, Koc Mahmut, Ozmen M Mahir, Kucuk N Ozlem, Ozalp Necdet, Aras Gulseren
Department of Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
Surgery. 2005 Nov;138(5):899-904. doi: 10.1016/j.surg.2005.04.014.
Gastric cancer continues to be a significant health problem around the world. Surgical resection with a lymph node dissection remains the only potentially curative treatment with gastric cancer. Determination of the extent of lymph node dissection required on the basis of actual node involvement in patients with gastric cancer is important as less extensive dissection may reduce postoperative morbidity and mortality rates. The current study examines the feasibility and reliability of sentinel lymph node biopsy in gastric cancer.
A total of 32 patients who underwent gastrectomy with extended lymphadenectomy were enrolled in this study. A total volume of 148 MBq (2 mL) technetium-99m-radiolabeled, filtered sulphur colloid solution was injected into the primary lesion under gastroscopy 2 hours before the operation. Lymph nodes were examined as soon as possible by a hand-held gamma probe during the operation, without significant manipulation of the stomach or greater omentum. A sentinel lymph node (SLN) was defined by a level of radioactivity 10 times higher than the background.
Thirty-one of 32 patients had successful SLN biopsy, with a success rate of 97%. The sensitivity, specificity, positive predictive value, and negative predictive value of SLN biopsy were 100%, 95%, 90%, and 100%, respectively.
SLN biopsy using gamma probe in gastric cancer is a feasible procedure with high sensitivity and accuracy. This technique may be of a great benefit to surgeons in planning the extend of lymph node dissection in gastric cancer.
胃癌在全球范围内仍是一个严重的健康问题。手术切除加淋巴结清扫仍然是胃癌唯一可能治愈的治疗方法。根据胃癌患者实际的淋巴结受累情况来确定所需的淋巴结清扫范围很重要，因为范围较小的清扫可能会降低术后发病率和死亡率。本研究探讨了前哨淋巴结活检在胃癌中的可行性和可靠性。
本研究共纳入32例行扩大淋巴结清扫胃切除术的患者。术前2小时在胃镜下将总量为148MBq（2mL）的99m锝标记的过滤硫胶体溶液注入原发灶。术中用手持式γ探测器尽快检查淋巴结，不对胃或大网膜进行显著操作。前哨淋巴结（SLN）定义为放射性水平比背景高10倍的淋巴结。
32例患者中有31例成功进行了SLN活检，成功率为97%。SLN活检的敏感性、特异性、阳性预测值和阴性预测值分别为100%、95%、90%和100%。
在胃癌中使用γ探测器进行SLN活检是一种可行的方法，具有高敏感性和准确性。该技术可能对外科医生规划胃癌淋巴结清扫范围有很大帮助。
