Development of sentinel lymph node identification using a new tracer of fluorescsnt beads for gastrointestinal carcinoma

本研究探讨了FBM对胃癌患者前哨淋巴结（SN）检测的有效性。川崎医科大学机构审查委员会在患者同意的情况下批准了荧光珠法（FBM）用于胃癌（GC）病例。手术前一天，通过内窥镜将荧光珠（FB） 1ml注射到病变周围粘膜下层的4个点。术中进行紫外线照射，提取淋巴结照射检测SN。假设发光淋巴结（LN）为SN。同时，在手术时从病变周围的浆膜侧注入浆膜下层，采用染色（ICG）法检测SN。ICG注射后15分钟，绿色节点可推定为SN。SN取样后，对I室和II室行淋巴结切除术。对24例早期胃癌患者进行SN检测。FBM的SN检出率为75%（18/24）。平均SN数为2.3个。FB联合ICG方法对SN的检出率为91.6%。单用FB的SN检出率较低。FBM应同时与ICG方法相结合。此外，由于脂肪组织的自身荧光，在手术过程中很难检测到隐藏在脂肪组织中的荧光LN。然而，通过紫外线照射切除提取组织，可以检测到SN。为了将来将FB应用于临床，需要设计一种新的紫外照射仪器来检测术中SN。

This study examined that availability of FBM for detecting of sentinel lymph node(SN) for patients with GC. Kawasaki Medical College Institutional Review Board approved the fluorescent beads methods(FBM) for the cases of gastric carcinoma(GC) under the patient's consent.On the day before surgery, 1ml of fluorescent beads(FB) was injected by an endoscope to four points of submucosal layer around the lesion. Ultraviolet (UV) irradiation was performed during the operation, and extracted lymph nodes were irradiated to detect SN. Light-emitting lymph nodes(LN) were assumed to be SN. At the same time, SN was detected by dye (ICG) methods injected into the subserosal layear from the serosal side surrounding a lesion at the operation time. During 15 minutes after the injection of ICG, green nodes could beb assumed to be SN. After the sampling of SN, a lymphadenectomy was done for compartments I and II. SN detection was performed for 24 patients with early GC. The SN detection rate was 75% (18/24 cases) in FBM. The average number of SN was 2.3. The SN detection rate using FB combined with ICG methods was 91.6%. The SN detection rate of FB alone was low. The FBM should be combined with ICG methods at the same time. Moreover, it was difficult to detect a fluorescent LN hidden in the adipose tissue during surgery because of autofluorescence of the adipose tissue. However, it was able to detected SN by UV irradiation to excision extraction tissue. For the purpose of application FB to clinical use in the future, a new UV irradiation instrumental should be devised to detect SN during the operation.