[Prospective comparative study of sentinel lymph node mapping in gastric cancer -- submucosal versus subserosal marking method].

BACKGROUND

Forty percent of patients with gastric cancer undergo unnecessary extended lymph node dissection which may result in higher rate of morbidity and mortality. Successful sentinel lymph node (SLN) mapping may help to reduce the number of extended lymphadenectomy. Various marking methods are in use to detect the sentinel lymph node in gastric cancer.

METHODS

Forty consecutive patients underwent open gastric resection with blue dye mapping and modified D2 lymph node dissection. Sixteen patients (group A) were marked submucosally with endoscopy and 24 patients (group B) were labelled by the surgeon subserosally. The staining method and the lymphadenectomy were supervised by the same surgeon.

RESULTS

A total of 795 lymph nodes were removed and examined. The mean number of blue nodes was 4.1 per patient in group A and 4.8 in group B. The false negative rate was 0% in group A and 7.7% in group B. The sensitivity and specificity of SLN mapping was 100% in the submucosal group. The specificity of subserosal marking method was 100%, while the seínsitivity was 92.3%. Submucosal and subserosal marking methods were proven to be equivalent in detection rate, sensitivity and specificity based on 90% confidence interval of the ratio of indicators.

CONCLUSIONS

Our results suggest that sentinel lymph node mapping with blue dye alone represents a safety procedure and seems to be adaptable with high sensitivity and specificity, especially in cases of T1 and T2 tumors.