Evaluation of lymph node micrometastasis in gastric cancer using magnetic cell sorting.

我们研究的目的是确定前哨淋巴结概念对胃癌的充分性。在34例患者中，术中尝试将吲哚菁绿和放射性同位素联合注射到肿瘤附近的胃粘膜下层。所有患者均行标准根治性胃切除术加淋巴结切除术，并行常规组织病理学检查评估切除淋巴结。前哨淋巴结检出率为94.1%（32/34）。检出的87例前哨淋巴结中，仅染色检出24例，仅放射性同位素检出50例，两种方法均检出23例。6个前哨淋巴结位于腹壁外。一例肌层浸润性癌在胃周围无放射性的绿色淋巴结转移。2例晚期癌症患者有淋巴结转移，但前哨淋巴结未检出癌细胞。染料和放射性同位素的结合似乎对成功检测前哨淋巴结很重要。免疫染色法和磁性细胞分选未发现前哨淋巴结微转移。我们的结果表明了胃内和胃外淋巴流的复杂性。虽然前哨淋巴结导航手术是一项很有前途的技术，但需要大规模的研究来建立胃癌前哨淋巴结的概念。

The aim of our study is to determine the adequacy the sentinel node concept to gastric cancer. Intraoperative lymphatic mapping was attempted in 34 patients using a combination of indocyanine green and radioisotope injected into the gastric submucosa adjacent to the tumor. Standard radical gastrectomy with lymphadenectomy was performed in all patients and the resected nodes were evaluated by routine histopathological examination. The rate of sentinel node detection was 94.1% (32/34). Among totally 87 of detected sentinel nodes, 24 nodes were detected by only dye, 50 nodes were detected by only radioisotope and 23 nodes were detected by both procedures. Six sentinel nodes were located beyond the perigastric area. A patient with muscular layer invasive cancer had metastasis in a green-dyed node without radioactivity in the perigastric area. Two advanced cancer patients had lymphnode metastases but cancer cells were not detected in the sentinel nodes. Combination of dye and radioisotope seems to be important for successful detection of sentinel nodes. Micrometastasis were not detected in the sentinel lymph nodes by immunostain finging and magnetic cell sorting. Our results indicate the complexity of lymphatic streams within and from the stomach. Although sentinel node navigation surgery is a promising technique, large-scale studies are needed to establish the sentinel node concept in gastric cancer.