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

我们的研究目的是确定前哨淋巴结概念对胃癌的适用性。在34例患者中，使用吲哚菁绿色和放射性同位素的组合注射到肿瘤附近的胃粘膜下层进行术中淋巴结定位。所有患者均行标准根治性胃切除加淋巴结清扫术，并对切除的淋巴结进行常规组织病理学检查。前哨淋巴结检出率为94.1%（32/34）。在87个前哨淋巴结中，24个仅用染料检测，50个仅用放射性同位素检测，23个用两种方法检测。6个前哨淋巴结位于胃周区以外。一名肌层浸润性癌患者在胃周区域的一个无放射性的绿色染色淋巴结中发生转移。两名晚期癌症患者有淋巴结转移，但在前哨淋巴结中未检测到癌细胞。结合染料和放射性同位素似乎是重要的前哨淋巴结的成功检测。前哨淋巴结免疫组化染色及磁性细胞分选均未发现微转移。我们的研究结果表明，复杂的淋巴流内和从胃。虽然前哨淋巴结导航手术是一种很有前途的技术，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.