How should tracers be injected to detect for sentinel nodes in gastric cancer – submucosally from inside or subserosally from outside of the stomach?

Yaguchi, Yoshihisa; Ichikura, Takashi; Ono, Satoshi; Tsujimoto, Hironori; Sugasawa, Hidekazu; Sakamoto, Naoko; Matsumoto, Yusuke; Yoshida, Kazumichi; Kosuda, Shigeru; Hase, Kazuo

doi:10.1186/1756-9966-27-79

Cited by 30 publications

(29 citation statements)

References 12 publications

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“…Some authors use dye alone [12,20,21] and others apply 99m Tc tin colloid imaging [9], while others use these two techniques in a parallel fashion [22]. Yaguchi et al [23] and Lee et al [24] have compared the subserosal with the submucosal labeling method without finding any significant differences. We have had an excellent outcome of SLN mapping with the blue dye-only method in breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Value of sentinel lymph node mapping using a blue dye-only method in gastric cancer: a single-center experience from North-East Hungary

Tóth¹,

Kincses²,

Plósz³

et al. 2011

Gastric Cancer

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Background Forty percent of patients with gastric cancer have unnecessarily extended lymph node dissections with higher rates of morbidity and mortality than those in nonextended procedures. Successful sentinel lymph node (SLN) mapping may help to reduce the number of extended lymphadenectomies. Methods SLN mapping was investigated by a blue dyeonly method in patients with gastric cancer. The first cohort of patients (n = 16) were marked submucosally by an endoscopist and in the second cohort of patients (n = 23) a subserosal injection was performed by the surgeon. Results Thirty-nine patients, all Caucasians, underwent gastric resection or total gastrectomy with SLN biopsy using patent blue-dye mapping and modified D2 lymphadenectomy. The mapping procedure and the lymphadenectomy were supervised by the same surgeon. A total of 770 lymph nodes were removed and examined. The mean number of blue nodes was 4.3 per patient. In 22/23 cases at least one SLN showed tumor involvement. The sensitivity of SLN mapping was 95.7%, the false-negative rate was 4.3%, and the specificity was 100%. The negative predictive value was 93.8% and the positive predictive value was 100%. In cases of T1 and T2 tumors the sensitivity was 100%. We found the two marking methods (submucosal vs. subserosal) to be equivalent and there was no side-effect of the blue-dye mapping. Conclusions Our results suggest that SLN mapping with blue dye alone represents a safe procedure that seems to be adaptable for non-obese patients undergoing open surgery for gastric cancer in the Eastern European region. The procedure has high sensitivity and specificity, especially in cases of T1 and T2 tumors.

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Section: Discussionmentioning

confidence: 99%

Value of sentinel lymph node mapping using a blue dye-only method in gastric cancer: a single-center experience from North-East Hungary

Tóth¹,

Kincses²,

Plósz³

et al. 2011

Gastric Cancer

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“…Several researchers reported that there was no difference in the detection rate, mean number of SNs, and sensitivity of the SN biopsies between submucosal and subserosal injection [19,20]. But submucosal injection seems theoretical because lymph flows from the mucosal side to the serosal side and cancer cells move in this direction.…”

Section: Injection Of Tracersmentioning

confidence: 99%

A new stage of sentinel node navigation surgery in early gastric cancer

et al. 2014

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Sentinel node (SN) navigation surgery is expected to realize organ-and function-preserving surgery with SN mapping, and has been applied in operations for breast cancer and melanoma. But there has been no definite evidence for the SN concept in gastric cancer. A prospective multicenter trial to confirm the SN concept for gastric cancer conducted by the Japan Society of Sentinel Node Navigation Surgery reported that the SN detection rate, sensitivity of positive SNs, and accuracy of nodal status are 97.5 % (387/397), 93 % (53/57), and 99 % (383/ 387), respectively. A detailed analysis of the trial suggested that strictly the ''lymphatic basin concept'' rather than the ''SN concept'' was confirmed in early gastric cancer. The Japan Society of Sentinel Node Navigation Surgery started a new trial of function-preserving gastrectomy with lymphatic basin dissection (LBD) for early gastric cancer without metastasis in SNs on the basis of this promising outcome of the trial. It is supposed that LBD guarantees curability in SN navigation surgery for early gastric cancer. Full-thickness resection or endoscopic submucosal dissection in combination with laparoscopic LBD will soon be a new treatment option for early gastric cancer.

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“…When injected at high enough concentrations, ICG likewise causes green "staining" of lymphatic vessels as it progresses to the draining LNs, which also become green and directly visible without the needed use of NIR fluorescence. Motomura et al [29] injected 25 mg subcutaneously for direct visualization of tumor-draining LNs in breast cancer patients, while Ichikura et al [30], Yaguchi, et al [31], and Park et al [32] likewise injected 5 -7.5 mg and 25 mg subcutaneously to visualize SLNs in gastric cancer patients. Given that both ICG and blue dyes both bind to globulin proteins within tissues, it may not be surprising that they are both avidly taken up by the lymphatics and that SLN mapping with ICG staining correlates well with standard blue dye staining [33,34].…”

Section: Sentinel Lymph Node Mappingmentioning

confidence: 99%

“…These studies suggest that for superficial tumor-draining lymph node basins, NIR fluorescence could supplant lymphoscintigraphy, which is typically performed with administration of 99m Tc radiocolloid followed by gamma camera imaging for surgical planning nuclear and gamma probe interrogation for intraoperative localization. Indeed, several studies suggest similar performance of lymphoscintigraphy and ICG fluorescence for identification of SLNs [19,30,31,37]. Although the advantages of using a non-radiative, nonspecific probe such as ICG are significant, it remains unclear whether they are great enough to warrant the replacement of the blue dye (administered at comparable doses that ICG was administered above) and/or 99m Tc radiocolloid as non-specific agents for resecting LNs for cancer staging.…”

Section: Sentinel Lymph Node Mappingmentioning

confidence: 99%

Near-Infrared Fluorescence Imaging in Humans with Indocyanine Green: A Review and Update~!2009-12-07~!2009-12-23~!2010-05-26~!

Marshall¹,

Rasmussen²,

Tan³

et al. 2010

TOSOJ

247

117

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Near-infrared (NIR) fluorescence imaging clinical studies have been reported in the literature with six different devices that employ various doses of indocyanine green (ICG) as a non-specific contrast agent. To date, clinical applications range from (i) angiography, intraoperative assessment of vessel patency, and tumor/metastasis delineation following intravenous administration of ICG, and (ii) imaging lymphatic architecture and function following subcutaneous and intradermal ICG administration. In the latter case, NIR fluorescence imaging may enable new discoveries associated with lymphatic function due to (i) a unique niche that is not met by any other conventional imaging technology and (ii) its exquisite sensitivity enabling high spatial and temporal resolution. Herein, we (i) review the basics of clinical NIR fluorescence imaging, (ii) survey the literature on clinical application of investigational devices using ICG fluorescent contrast, (iii) provide an update of non-invasive dynamic lymphatic imaging conducted with our FDPM device, and finally, (iv) comment on the future NIR fluorescence imaging for non-invasive and intraoperative use given recent demonstrations showing capabilities for imaging following microdose administration of contrast agent.

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How should tracers be injected to detect for sentinel nodes in gastric cancer – submucosally from inside or subserosally from outside of the stomach?

Cited by 30 publications

References 12 publications

Value of sentinel lymph node mapping using a blue dye-only method in gastric cancer: a single-center experience from North-East Hungary

Value of sentinel lymph node mapping using a blue dye-only method in gastric cancer: a single-center experience from North-East Hungary

A new stage of sentinel node navigation surgery in early gastric cancer

Near-Infrared Fluorescence Imaging in Humans with Indocyanine Green: A Review and Update~!2009-12-07~!2009-12-23~!2010-05-26~!

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