scholarly journals Sentinel Lymph Node Mapping In Gastric Cancer Surgery: Current Status

2016 ◽  
Vol 62 (4) ◽  
pp. 403-407 ◽  
Author(s):  
Tivadar Bara ◽  
Tivadar Bara ◽  
Radu Neagoe ◽  
Daniela Sala ◽  
Simona Gurzu ◽  
...  

AbstractLymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion. The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.

Author(s):  
Ahmed A. Elbatrawy ◽  
Da Sol Lee ◽  
Sang Bong Lee ◽  
Hui-Jeon Jeon ◽  
Sijoon Lee ◽  
...  

Near-infrared (NIR) fluorescent imaging agents with biocompatibility and high sensitivity are urgently required for the accurate detection of sentinel lymph nodes (SLNs). Herein, we report the design of a novel...


2019 ◽  
Vol 29 (1) ◽  
pp. 53-59
Author(s):  
J A Harold ◽  
D Uyar ◽  
J S Rader ◽  
E Bishop ◽  
M Nugent ◽  
...  

ObjectiveTo identify factors that affect successful adaptation of sentinel lymph node mapping and those that lead to unintended adipose-only sentinel lymph node identification.MethodsSurgical and pathological data were prospectively collected on patients with endometrial cancer who underwent sentinel lymph node mapping with indocyanine green with or without pelvic and/or para-aortic lymph node dissection between November 2013 and April 2017. All mapping cases were performed with the robotic system. Adipose-only specimens were defined as a sentinel lymph node without a pathologically identified lymph node after ultrastaging.ResultsA total of 202 patients were included: 83% had endometrioid pathology, 12% serous, 3% carcinosarcoma, and 2% clear cell, with mixed pathology noted in 2%. The bilateral sentinel lymph node detection rate was 66%, and the rate of mapping at least a unilateral sentinel lymph node was 86%. Neither the bilateral nor the unilateral sentinel lymph node mapping rate changed with increased surgeon experience. The rate of adipose-only sentinel lymph node identification was more frequent when comparing the first 10 cases (37%), cases 11 – 30 (28%), and > 30 cases (9%) (P = 0.006). Body mass index > 30 kg/m2, uterine fibroids, The International Federation of Gynecology and Obstetrics (FIGO) grade, and histology were not found to have a statistically significant impact on either sentinel lymph node identification or adipose-only sentinel lymph node identification. Adipose-only sentinel lymph nodes were more likely with increased time from cervical injection to identification of the sentinel lymph node in the right hemipelvis. The median range was 28 min (14–73) for true sentinel lymph node identification vs 33 min (23–74) for adipose-only sentinel lymph node identification (P = 0.02).ConclusionPatient and surgeon factors did not impact the identification of sentinel lymph nodes over time. Adipose-only sentinel lymph nodes were more frequently identified in the initial cases and represent a potential complication to adapting sentinel lymph node biopsy without lymphadenectomy. The increase in adipose-only sentinel lymph node identification that was associated with time from cervical injection may represent delayed or disrupted uptake of indocyanine green.


2016 ◽  
Vol 27 (1) ◽  
pp. 154-158 ◽  
Author(s):  
Yasser Diab

ObjectiveA comprehensive literature search for more recent studies pertaining to sentinel lymph node mapping in the surveillance of cervical cancer to assess if sentinel lymph node mapping has sensitivity and specificity for evaluation of the disease; assessment of posttreatment response and disease recurrence in cervical cancer.Materials and MethodsThe literature review has been constructed on a step wise study design that includes 5 major steps. This includes search for relevant publications in various available databases, application of inclusion and exclusion criteria for the selection of relevant publications, assessment of quality of the studies included, extraction of the relevant data and coherent synthesis of the data.ResultsThe search yielded numerous studies pertaining to sentinel lymph node mapping, especially on the recent trends, comparison between various modalities and evaluation of the technique. Evaluation studies have appraised high sensitivity, high negative predictive values and low false-negative rate for metastasis detection using sentinel lymph node mapping. Comparative studies have established that of all the modalities for sentinel lymph node mapping, indocyanine green sentinel lymph node mapping has higher overall and bilateral detection rates. Corroboration of the deductions of these studies further establishes that the sentinel node detection rate and sensitivity are strongly correlated to the method or technique of mapping and the history of preoperative neoadjuvant chemotherapy.ConclusionsThe review takes us to the strong conclusion that sentinel lymph node mapping is an ideal technique for detection of sentinel lymph nodes in cervical cancer patients with excellent detection rates and high sensitivity. The review also takes us to the supposition that a routine clinical evaluation of sentinel lymph nodes is feasible and a real-time florescence mapping with indocyanine green dye gives better statistically significant overall and bilateral detection than methylene blue.


2018 ◽  
Vol 64 (3) ◽  
pp. 335-344
Author(s):  
Aleksey Karachun ◽  
Yuriy Pelipas ◽  
Oleg Tkachenko ◽  
D. Asadchaya

The concept of biopsy of sentinel lymph node as the first lymph node in the pathway of lymphogenous tumor spread has been actively discussed over the past decades and has already taken its rightful place in breast and melanoma surgery. The goal of this method is to exclude vain lymphadenectomy in patients without solid tumor metastases in regional lymph nodes. In the era of minimally invasive and organ-saving operations interventions it seems obvious an idea to introduce a biopsy of sentinel lymph node in surgery of early gastric cancer. Meanwhile the complexity of lymphatic system of the stomach and the presence of so-called skip metastases are factors limiting the introduction of a biopsy of sentinel lymph node in stomach cancer. This article presents a systematic analysis of biopsy technology of signaling lymph node as well as its safety and oncological adequacy. Based on literature data it seems to us that the special value of biopsy of sentinel lymph nodes in the future will be in the selection of personalized surgical tactics for stomach cancer.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Satomi Sugiyama ◽  
Toshinori Iwai ◽  
Toshiharu Izumi ◽  
Keita Ishiguro ◽  
Junichi Baba ◽  
...  

Abstract Background The objectives of this retrospective study were to evaluate the usefulness of computed tomography lymphography (CTL) and to clarify the optimal timing of CTL in sentinel lymph node (SLN) mapping of clinically N0 early oral cancer. Methods Twenty patients with clinically N0 early oral cancer underwent CTL with a 128 multi-detector row CT scanner to detect SLN the day before resection of primary tumor and SLN biopsy with indocyanine green (ICG) fluorescence guidance. CT scanning was performed in the first 10 patients at 2, 5, and 10 min after submucosal injection of iopamidol and in the remaining 10 patients at 2, 3.5, 5, and 10 min after the injection of contrast medium. We evaluated the SLN detection rate at each scan timing and the number and location of SLNs. We evaluated whether CTL-enhanced SLNs could be identified intraoperatively as ICG fluorescent lymph nodes. Results SLNs were detected by CTL in 19 of the 20 patients (95.0%), and the mean number of SLNs was 2 (range, 1–4). All SLNs were located on the ipsilateral side; 35 of 37 SLNs were located at level I and II, and 2 SLNs were lingual lymph nodes. All SLNs could be detected 2 min and 3.5–5 min after contrast medium injection, and CTL-enhanced SLNs could be identified intraoperatively as fluorescent lymph nodes. Conclusions CTL could facilitate the detection of SLNs in early oral cancer, and the optimal timing of CT scanning was at 2 and 5 min after injection of contrast medium.


2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 76-76
Author(s):  
M. Niihara ◽  
H. Takeuchi ◽  
S. Kamiya ◽  
T. Kaburagi ◽  
T. Oyama ◽  
...  

76 Background: Some papers have reported that sentinel lymph node (SLN) concept can be applied in patients with early gastric cancer, in particular clinically T1N0M0 or T2N0M0 with a tumor diameter of 4cm or less. Little is, however, available on the SLN study with the other criteria than listed above. The aim of the present work was to investigate the accuracy of the SLN biopsy of gastric cancer with various stages and evaluate the indication for SLN navigated gastrectomy. Methods: A total of 431 consecutive patients were diagnosed with operable gastric cancer during the period April 1999 through December 2007. Reasons for inclusion were, in principle, T1N0M0 or T2N0M0 gastric cancer. However, several patients diagnosed preoperatively with T3N0M0, T2N1M0, remnant gastric cancer, multiple gastric cancers and additional treatment after endoscopic therapy were also enrolled in this study according to their request. All patients underwent a radical gastrectomy with SLN mapping with an informed consent. The SLNs were identified using both radio-guided and dye-guided method. Results: Detection rate of hot and/or blue node was 95.8% (413/431). The accuracy of metastatic status based on SLN was 97.6% (403/413). In six of 10 false-negative cases, some clinical backgrounds and problems were present; scirrhous gastric cancer, the tumor penetration of serosa, multiple lesions, remnant gastric cancer after partial resection and the technical issue of tracer injection. Nine of these 10 false-negative cases had the metastatic lymph nodes within only the sentinel basins. Specifically, in the group of clinically T1N0M0 untreated gastric cancer with a tumor diameter of 4 cm or less, there were only 3 false- negative cases. In addition, all the metastatic lymph nodes of the 3 cases located within the sentinel basins. Conclusions: Our study suggested that SLN concept for untreated early gastric cancer could be validated. The sentinel basin dissection might be used to advantage to improve curativity for gastric cancer. No significant financial relationships to disclose.


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