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May 2002. Review Article.
Following a preliminary article published ( 2 ), Kitagawa et al.affirm that radio-guided SN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with early-stage gastric cancer.
Clinical diagnosis was made by examination of endoscopic biopsy specimens, and the absence of apparent lymph node involvement by diagnostic imaging was confirmed by preoperative CT and conventional ultrasonography. The depth of tumour invasion was evaluated on the basis of endoscopic findings and double contrast gastrography. One hundred and forty-five patients requiring curative gastrectomy with D2 or modified D2 lymphadenectomy (removal of all N1 nodes and nodes along the left gastric artery and common hepatic artery) with a diagnosis of clinical T1 or T2, N0 M0 status were enrolled.
In gastrointestinal cancers, the lymphatic network may be more complex than that in breast cancer, and it may be difficult to visualize all the SNs distributed in unexpected areas by the vital blue dye method. In fact, the current data indicated a relatively high incidence (approximately one-third) of direct distribution of radioactive tracer in the second regional lymph node compartment in gastric cancer. This may be the major mechanism of so-called skip metastasis in gastric cancer. In these cases, SNs in the second compartment are considered functionally to be first compartment.
In the field of surgical treatment of gastric cancer, successful SN mapping has great potential to detect micrometastatic disease by focusing on SNs as selected targets for evaluation and for recognition of unusual lymph drainage.
Furthermore, this technique has great potential application for development of novel minimally invasive surgical techniques. Curative laparoscopic surgery for mucosal gastric cancer has been reported . Laparoscopic wedge resection with a safe surgical margin should be sufficient for curative treatment of early gastric cancer without lymph node metastasis. In fact, laparoscopic detection of SNs in gastric cancer using an abdominal probe (AutoSuture Japan, Tokyo, Japan) was feasible in a preliminary study. Several issues, such as the sensitivity of intraoperative pathological examination and the technique of laparoscopic SN detection, remain to be resolved before wide clinical application of this procedure. However, from this initial experience, it is reasonable to conclude that radio-guided SN detection has potential value in the staging and treatment of patients with early gastric cancer ( 1 ).
1) Y. Kitagawa, H. Fujii, M. Mukai, T. Kubota, Y. Otani and M. Kitajima. Radio-guided sentinel node detection for gastric cancer. British Journal of Surgery, Volume 89 Issue 5 Page 604 - May 2002.
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