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

Abstract

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.

Prospective, comparative study for the evaluation of lymph node involvement in gastric cancer: Maruyama computer program versus sentinel lymph node biopsy

“…Sampling of station 10 and compartment 3 nodes (13-16) was optional if macroscopically suspicious, so we did not routinely calculate the values of these stations. Our SLN marking method and the histological examination were described earlier [12]. The position of lymph nodes was labelled according to the Japanese classification of gastric carcinoma (JCGC) [13].…”

“…Studies from Japan and from Western Europe have demonstrated a high detection rate (93.7 %) and an accuracy of 92 % for SLN biopsy in patients with gastric cancer [11]. We have evaluated, for the first time in Hungary, the validity of SLN mapping using a blue dye-only method in gastric cancer [12].…”

Clinical significance of lymphadenectomy in patients with gastric cancer

“…However, preoperative diagnostic tools have a low sensitivity and specificity for defining these patient subpopulations. Sensitivity, specificity and accuracy of spiral computer tomography for detection of pathologic LN involvement are 73.1%, 50.0% and 84.2%, respec tively [11,12] . Endoscopic ultrasonography has an accuracy of 68.6%, with a sensitivity and specificity of 66.7% and 73.7%, respectively [11,13] .…”

“…Sensitivity, specificity and accuracy of spiral computer tomography for detection of pathologic LN involvement are 73.1%, 50.0% and 84.2%, respec tively [11,12] . Endoscopic ultrasonography has an accuracy of 68.6%, with a sensitivity and specificity of 66.7% and 73.7%, respectively [11,13] . The real problem of these imaging procedures is that exclusion of endoscopic ultrasonography, only the size of the LNs is taken into account.…”

“…Successful estimation of LN involvement may help to define which patients would or would not benefit from an extended LN dissection in association with gastrec tomy [11] . However, preoperative diagnostic tools have a low sensitivity and specificity for defining these patient subpopulations.…”