Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea.
Ann Surg Oncol. 2013 Jul;20(7):2296-303. doi: 10.1245/s10434-012-2855-8. Epub 2013 Jan 22.
Current sentinel node (SN) detection techniques require a learning period and tracers have many disadvantages for practical use. The purpose of this study was to evaluate the feasibility of preoperative computed tomography (CT) lymphography using lipiodol for detecting SNs in gastric cancer.
A total of 24 patients who underwent laparoscopic surgery for early gastric cancer were enrolled in this study. Noncontrast CT images were obtained 1-2 h after endoscopic submucosal peritumoral injection of 1 mL of lipiodol the day before surgery. The final sentinel basins (SBs) were decided by the dual tracer method (indocyanine green plus (99m)Tc-antimony sulfur colloid) during laparoscopic gastrectomy. SN detection rate by preoperative CT lymphography using lipiodol and agreement between CT lymphography versus dual tracer method were evaluated. The agreement was confirmed with soft X-ray radiography of detected SBs.
Technical failure of endoscopic lipiodol injection occurred in one patient. SNs were successfully detected in the remaining 23 patients (95.8 %), whereas the intraoperative SB detection rate using the dual method was 100 %. The agreement rate, defined as the concordance between two methods or inclusion of SNs detected by CT lymphography in SBs by the dual tracer method, was 87 %.
Our initial experience of CT lymphography using lipiodol shows good potential in predicting SBs of gastric cancer preoperatively. However, SN detection by CT lymphography and the dual method should be applied complementarily in gastric cancer because discrepancies between these methods occur.
目前的前哨淋巴结（SN）检测技术需要一定的学习周期，示踪剂在实际应用中存在许多缺点。本研究旨在评估术前使用碘化油进行计算机断层扫描（CT）淋巴造影术检测胃癌 SN 的可行性。
本研究共纳入 24 例接受腹腔镜早期胃癌手术的患者。手术前一天，在经内镜黏膜下肿瘤周围注射 1 mL 碘化油后 1-2 小时，进行非增强 CT 扫描。在腹腔镜胃切除术中，采用双示踪剂法（吲哚菁绿加（99m）Tc-锑硫胶体）确定最终的前哨淋巴结盆地（SB）。评估术前 CT 淋巴造影术检测 SN 的准确率，以及 CT 淋巴造影术与双示踪剂法的一致性。通过对检测到的 SB 进行软 X 射线放射照相术来确认一致性。
1 例患者内镜下碘化油注射技术失败。其余 23 例患者（95.8%）SN 成功检出，而术中采用双示踪剂法的 SB 检出率为 100%。以两种方法的一致性或 CT 淋巴造影术检测到的 SN 被双示踪剂法包含在 SB 内的定义，一致性率为 87%。
我们使用碘化油进行 CT 淋巴造影术的初步经验显示，其在术前预测胃癌 SB 方面具有良好的潜力。然而，SN 检测的 CT 淋巴造影术和双示踪剂法应互补应用，因为这两种方法之间存在差异。
