Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2024 Oct;31(10):6959-6969. doi: 10.1245/s10434-024-15642-w. Epub 2024 Aug 3.
Lymph node metastasis is a critical prognostic factor for patients with gastric carcinoma (GC). Sentinel lymph node (SLN) mapping has the potential to identify the initial site of draining lymph node metastasis and reduce the extent of surgical lymphadenectomy. This study aimed to evaluate the diagnostic accuracy of SLN mapping in GC.
The study enrolled 129 GC patients undergoing total or partial gastrectomy with D2 lymphadenectomy and indocyanine green fluorescence-guided SLN mapping. The primary outcomes were the negative predictive value (NPV) and sensitivity of SLN mapping. The secondary outcomes were clinicopathologic factors associated with SLN mapping accuracy and successful SLN mapping.
The SLN detection rate in this study was 86.8 %. The study had an overall NPV of 83.1 % and an overall sensitivity of 65.8 %. The NPV was found to be significantly higher in the patients with no lymphovascular invasion (LVI) than in those with LVI (96.0 % vs 59.3 %; p < 0.001) and in the patients whose pathologic T (pT) stage lower than 3 than in those whose T stage was 3 or higher (92.0 % vs 66.7 %; p = 0.009). The sensitivity of SLN mapping was 50 % in the patients with no LVI and 33 % in the patients with a pT stage lower than 3.
The study results showed that for patients with early-stage GC with no LVI, negative SLN findings may represent a potential additive predictor indicating the absence of regional LN metastasis. However, given the low sensitivity rates noted, further research is needed to identify specific patient populations that may benefit from SLN mapping in GC.
淋巴结转移是胃癌（GC）患者的一个关键预后因素。前哨淋巴结（SLN）绘图有可能识别引流淋巴结转移的初始部位，并减少手术淋巴结清扫的范围。本研究旨在评估 SLN 绘图在 GC 中的诊断准确性。
本研究纳入了 129 例接受全胃或部分胃切除术和 D2 淋巴结清扫术以及吲哚菁绿荧光引导 SLN 绘图的 GC 患者。主要结局是 SLN 绘图的阴性预测值（NPV）和灵敏度。次要结局是与 SLN 绘图准确性和成功 SLN 绘图相关的临床病理因素。
本研究的 SLN 检出率为 86.8%。总的 NPV 为 83.1%，总灵敏度为 65.8%。结果发现，无淋巴血管侵犯（LVI）的患者的 NPV 明显高于有 LVI 的患者（96.0%比 59.3%；p<0.001），且病理 T（pT）分期低于 3 期的患者的 NPV 明显高于 T 分期为 3 期或更高的患者（92.0%比 66.7%；p=0.009）。无 LVI 的患者的 SLN 绘图灵敏度为 50%，pT 分期低于 3 期的患者的灵敏度为 33%。
研究结果表明，对于无 LVI 的早期 GC 患者，阴性 SLN 结果可能代表区域淋巴结转移缺失的潜在附加预测因素。然而，鉴于注意到的低灵敏度率，需要进一步研究以确定可能从 GC 中的 SLN 绘图中受益的特定患者人群。
