Sentinel node navigation in gastric cancer: new horizons for personalized minimally invasive surgical oncology?

Lianos, Georgios D; Hasemaki, Natasha; Vaggelis, Georgios; Karampa, Anastasia; Anastasiadi, Zoi; Lianou, Aikaterini; Papanikolaou, S.; Floras, Grigorios; Bali, Christina; Lekkas, Epameinondas; Katsios, Christos; Mitsis, Michail

doi:10.21037/tgh.2016.12.02

Cited by 5 publications

(2 citation statements)

References 44 publications

(49 reference statements)

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“…Except for combination of the HE and IHC method, multistep level sections, reverse transcription polymerase chain reaction (RT-PCR), and the one-step nucleic acid amplification assay (OSNA) have all been developed to improve the sensitivity of intraoperative pathologic diagnosis and detect SLN micrometastases. Moreover, many of these novel methods can be completed in 30 min which is convenient for intraoperative application [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and diagnostic performance of dual-tracer-guided sentinel lymph node biopsy in cT1-2N0M0 gastric cancer: a systematic review and meta-analysis of diagnostic studies

et al. 2017

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BackgroundDual-tracer-guided sentinel lymph node (SLN) biopsy may provide a promising diagnostic tool to assess accurately the status of lymph node metastasis in the surgical operation and assure the oncologic safety of the function or stomach preserving surgery. The diagnostic performance of this technology in recent studies varied. Thus, we conducted this meta-analysis.MethodsThis systematic review and meta-analysis was registered at the PROSPERO. Eligible studies were searched in the PubMed, EMBASE, Web of Knowledge, and Cochrane Library databases. A random-effect model was used to pool the data. Summary receiver operator characteristic curves, analysis for publication bias, meta-regression, and subgroup analysis were also performed.ResultsThe pooled SLN identification rate and sensitivity were 0.97 and 0.89. 99mTc-human serum albumin with indocyanine green (ICG), 99mTc-antimony sulfur colloid with ICG, performing SLN biopsy ≥15 min after dye injection, an SLN ≥5, the basin dissection, laparoscopic surgery, in studies conducted in Japan and studies published after 2012, were associated with higher sensitivity. CT1 stage, performing SLN biopsy ≥15 min after dye injection, in studies conducted in Japan and studies published after 2012, were related with a higher identification rate.ConclusionsDual tracer is promising in SLN biopsy in gastric cancer, and the clinical application of SLN biopsy should be limited to the patients of cT1N0M0 gastric cancer. The combination of 99mTc-human serum albumin and ICG as well as the combination of 99mTc-antimony sulfur colloid and ICG may be the optimal tracer combination. However, it seems not justified to put this technique into routine clinical application recently. Some factors that might enhance diagnostic value are identified.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-017-1159-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Feasibility and diagnostic performance of dual-tracer-guided sentinel lymph node biopsy in cT1-2N0M0 gastric cancer: a systematic review and meta-analysis of diagnostic studies

et al. 2017

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“…In general, SLN mapping and biopsy is indicated in patients with T1 or T2 tumors; primary lesions < than 4 cm in diameter; and clinical N0 gastric cancer. [27]. The injection method and selection of tracers for SLN mapping in gastric cancer remain controversial.…”

Section: Sentinel Lymph Node Detection Techniquesmentioning

confidence: 99%

Clinical Aspects of Sentinel Lymph Node Biopsy in Gastric Cancer

Tóth

2018

BJSTR

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Forty percent of patients with gastric cancer are node negative, so they have an unnecessarily extended lymph node dissection with a higher rate of morbidity and mortality. Successful sentinel lymph node (SLN) mapping may help to reduce the number of extended lymphadenectomy. Sentinel lymph node biopsy (SNB) is indicated in patients with T1 or T2 tumors; primary lesions < than 4 cm in diameter; and clinical N0 gastric cancer. The injection method and selection of tracers for SLN mapping in gastric cancer remain controversial. However, the use of dual tracer and in cases with non-palpable lesions, the submucosal marking method is recommended. The identification rate and sensitivity are the highest in time performing SLN biopsy after dye injection ≥15 min, the number of SLNs ≥5 and application of the basin dissection. The cardinal problem in the SNB concept is the intraoperative false negative rate, the combination of hematoxylin-eosin and immunohistochemical staining has the highest sensitivity of intraoperative pathologic detection by frozen tissue sections.The application of SNB has a beneficial side effect, as it significantly increased the number of harvested LN and the ratio of the number of the harvested LN per time, although an extensive surgical experience is necessary for application of SNB concept. If the SLN contains tumor deposit(s), extended dissection is warranted, but if findings are negative, the patient could be spared additional complications associated with extended dissection. Finally, the SNB could be suitable for tumors following endoscopic resection and could represent a new era of sentinel node navigation surgery in early gastric cancer. However, the clinical application of SLN biopsy should be limited to the patients of cT1N0M0 gastric cancer within the confines of prospective randomized trial.

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