【Gastroenterology】早期胃癌腹腔镜前哨淋巴结活检

Abstract. Sentinel node (SN) biopsies might be useful for performing
minimally invasive surgery without interrupting surgical curability. This
study examined the cause of false negativity during laparoscopic lymphatic
mapping and SN biopsies for early-stage gastric cancer. Thirtyseven
patients with gastric cancer (preoperative stage T1-2 or N0) who
underwent laparoscopic lymph node mapping and SN biopsies between
March 2001 and June 2004 were enrolled in this study. The tracer, patent
blue and technecium-99m-labeled tin colloid, was injected endoscopically.
Blue-stained or radioactive nodes were defined as SNs. Gastrectomy with
lymphadenectomy was performed then the results of the SN biopsies were
compared with the final diagnosis of the removed lymph nodes in permanent
sections. Sentinel nodes were successfully identified in 35 patients
(94.6%), and they were positive in 3 of 4 patients with metastatic lymph
nodes; sensitivity was 75% and specificity was 100%. Sentinel node status
could therefore be used to diagnose lymph node status with 97.1%
accuracy. Of 6 SNs with metastasis, 5 showed radioactivity, and only 2
were blue stained. In the false negative case, a radioactive SN with
metastasis in the right paracardial region was missed during laparoscopic
mapping. An error in laparoscopic intracorporeal detection of the
radioactive node with metastasis occurred because we could not eliminate
the shine-through effect. We found that during laparoscopic SN mapping
there is a high risk of false negativity with SNs located in the right
paracardial region. To apply laparoscopic SN mapping to early-stage
gastric cancer patients, the shine-through effect must be eliminated because
radiotracers are essential for this method.