Aikou Takashi, Kitagawa Yuko, Kitajima Masaki, Uenosono Yoshikazu, Bilchik Anton J, Martinez Steve R, Saha Sukamal
Department of Surgical Oncology and Digestive Surgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Cancer Metastasis Rev. 2006 Jun;25(2):269-77. doi: 10.1007/s10555-006-8507-3.
Precise evaluation of lymph node status is one of the most important factors in determining clinical outcome in treating gastro-intestinal (GI) cancer. Sentinel lymph node (SLN) mapping clearly has become highly feasible and accurate in staging GI cancer. The lunchtime symposium focused on the present status of SLN mapping for GI cancer. Dr. Kitigawa proposed a new strategy using sentinel node biopsy for esophageal cancer patients with clinically early stage disease. Dr. Uenosono reported on whether the SLN concept is applicable for gastric cancer through his analysis of more than 180 patients with cT1-2, N0 tumors. The detection rate was 95%, the false negative rate of lymph node metastasis including micro-metastasis was 4%, and accuracy was 99% in gastric cancer patients with cT1N0. Dr. Bilchik recommended the best technique for identifying SLNs in colorectal cancer: a combination of radiotracer and blue dye method, emphasizing that this technique will become increasingly popular because of the SLN concept, with improvement in staging accuracy. He stressed that this novel procedure offers the potential for significant upstaging of GI cancer. Dr. Saha emphasized that SLN mapping for colorectal cancer is highly successful and accurate in predicting the presence or absence of nodal disease with a relatively low incidence of skip metastases. It provided the "right nodes" to the pathologists for detailed analysis for appropriate staging and treatment with adjuvant chemotherapy. Although more evidence from large-scale multicenter clinical trials is required, SLN mapping may be very useful for individualizing multi-modal treatment for esophageal cancer and might be widely acceptable even for GI cancer.
准确评估淋巴结状态是决定胃肠道（GI）癌临床治疗结果的最重要因素之一。前哨淋巴结（SLN）定位在胃肠道癌分期中显然已变得高度可行且准确。本次午餐会研讨会聚焦于胃肠道癌SLN定位的现状。北川博士提出了一种针对临床早期食管癌患者采用前哨淋巴结活检的新策略。上野园博士通过对180余例cT1 - 2、N0期肿瘤患者的分析，报告了SLN概念是否适用于胃癌。在cT1N0期胃癌患者中，检测率为95%，包括微转移在内的淋巴结转移假阴性率为4%，准确率为99%。比尔奇克博士推荐了在结直肠癌中识别SLN的最佳技术：放射性示踪剂与蓝色染料法相结合，并强调由于SLN概念，随着分期准确性的提高，该技术将越来越受欢迎。他强调这种新方法有可能显著提高胃肠道癌的分期。萨哈博士强调，结直肠癌的SLN定位在预测有无淋巴结疾病方面非常成功且准确，跳跃转移发生率相对较低。它为病理学家提供了“正确的淋巴结”，以便进行详细分析，用于适当的分期和辅助化疗治疗。尽管需要更多来自大规模多中心临床试验的证据，但SLN定位可能对食管癌的个体化多模式治疗非常有用，甚至可能被广泛接受用于胃肠道癌。
