Yanagita Shigehiro, Natsugoe Shoji, Uenosono Yoshikazu, Arima Hideo, Kozono Tsutomu, Ehi Katsuhiko, Arigami Takaaki, Higashi Hiroshi, Aikou Takashi
Department of Surgical Oncology and Digestive Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Ann Surg Oncol. 2008 Mar;15(3):770-6. doi: 10.1245/s10434-007-9713-0. Epub 2007 Dec 19.
The TNM classification defines micrometastasis (MM) and isolated tumor cells (ITC) in lymph nodes (LN). Sentinel node (SN) navigation surgery has been introduced in gastrointestinal cancer. Few reports have examined the morphological distribution of MM and ITC of SN in gastric cancer. The purpose of this study was to clarify the clinical significance of the morphological distribution of cancer cells in SNs according to metastasis (MA), MM, and ITC.
All dissected LNs obtained from 160 consecutive patients with mapped SNs arising from cT1-2 N0 tumors were examined. Metastasis in these LNs was examined by histology and cytokeratin staining. The distribution of MA, MM, and ITC was classified as marginal sinus (MS), intermediate sinus (IS), parenchymal (PA), and diffuse types (DF).
Nodal metastases were detected in 65 SNs from 30 patients and MA, MM, and ITC accounted for 53.9%, 21.5%, and 24.6%, respectively. MS, IS, PA, and DF accounted for 57%, 6%, 17%, and 20.0%, respectively. Patients with metastasis of non-MS had more nodal metastasis in non-SNs (P = .025) and had nodal metastasis in second tier (P = .009), compared with the patients with metastasis of MS. The incidence of metastasis in non-MS was higher in tumors larger than 40 mm than those smaller than 40 mm (P = .011).
When performing SN navigation surgery in gastric cancer, we should keep in mind that the patients with tumor larger than 40 mm in size and nodal metastasis of non-MS may have non-SN metastasis and nodal metastasis in second tier.
TNM 分类法对淋巴结（LN）中的微转移（MM）和孤立肿瘤细胞（ITC）进行了定义。前哨淋巴结（SN）导航手术已被引入胃肠道癌的治疗。很少有报告研究胃癌中 SN 的 MM 和 ITC 的形态学分布。本研究的目的是根据转移（MA）、MM 和 ITC 来阐明 SN 中癌细胞形态学分布的临床意义。
检查了 160 例连续的 cT1-2 N0 肿瘤患者的所有已解剖的 LN，这些患者的 SN 已被标记。通过组织学和细胞角蛋白染色检查这些 LN 中的转移情况。MA、MM 和 ITC 的分布分为边缘窦（MS）、中间窦（IS）、实质（PA）和弥漫型（DF）。
在 30 例患者的 65 个 SN 中检测到淋巴结转移，MA、MM 和 ITC 分别占 53.9%、21.5%和 24.6%。MS、IS、PA 和 DF 分别占 57%、6%、17%和 20.0%。与 MS 转移患者相比，非 MS 转移患者在非 SN 中有更多的淋巴结转移（P = 0.025），且在二级淋巴结中有转移（P = 0.009）。肿瘤大于 40 mm 的患者中非 MS 转移的发生率高于小于 40 mm 的患者（P = 0.011）。
在胃癌中进行 SN 导航手术时，我们应牢记，肿瘤大小大于 40 mm 且有非 MS 淋巴结转移的患者可能有非 SN 转移和二级淋巴结转移。
