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The usefulness of sentinel lymph node detection using fluorescent beads for gastric cancer

使用荧光珠检测前哨淋巴结对胃癌的有用性

基本信息

批准号：
18591489
负责人：
HIRAI Toshihiro
金额：
$ 0.95万
依托单位：
Kawasaki Medical School
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2006
资助国家：
日本
起止时间：
2006 至 2007
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-18591489/
关键词：
sentinel lymph node fluorescent beads gastric cancer micrometastasis

项目摘要

This study investigated the availability of fluorescent beads (FB) methods for detecting of sentinel lymph node (SN) for patients with gastric carcinoma (GC). We hypothesized that the fluorescent beads might reflect the flow of cancer cells in lymphatic vessels, because a particulate diameter of the fluorescent beads was similar to a cancer cell.On the day before surgery, 1ml of 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 subserasal layear from the serosal side surrounding a lesion at the operation time. SN detection was performed for 25 patients with early GC. The SN detection rate was 76% (19/25) in FB methods. The average number of SN was 2.3. The SN detection rate using FB combined with ICG metho … More ds was 92%(23/25). We investigated the distribution of fluorescent beads SN for an early cancer eases according to a primary tumor site. One case in the upper part, SN was detected in compartment I. Fourteen cases in the middle part, SN were detected in compartment I(76%), and compartment II(24%). Five cases in the lower part, the SN were detected in compartment I(88%), and compartment II(12%). We recognized one false-negative case. In that case, the metastatic lymph node was detected out of the area of SN station. The size of tumor in this case was 75×40mm, therefore the large size tumor should not be indicated for SN detection. A metastasis positive case in early cancer was only this false-negative case. We could not reveal the accuracy of FB method because of small number of early gastric cancer. Moreover, it was difficult to detect a fluorescent LN hidden in the adipose tissue during surgery because of autofluorescence of the adipose 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 and the FB methods should be combined with other tracer at the same time. Another point should be investigated is a micrometastasis, because it might contribute to the patients prognosis. Therefore we used anticytokeratin (AE1/AE3) for all resected lymph nodes and investigated micrometastasis in 25 early gastric cancer cases. In three cases, we detected micrometastasis. One case of them was situated out of SN station, which was detected by combined FB and dye method. Therefore, we examined whether the presence of micrometastasis influence to the prognosis for gastric cancer cases. However we couldn't recognize the significant difference between positive and negative of micrometastasis. We concluded that the presence of micrometastasis didn't contribute to the poorer prognosis.From these results, SN navigation surgery could be indicated for early GC by dye or combined FB methods with the lymph nodes dissection of SN station. However, the usefulness of FB method could not be revealed because of our small number of cases. Less

本研究探讨了荧光微球（FB）法检测胃癌前哨淋巴结（SN）的可行性。我们假设荧光珠可能反映了淋巴管中癌细胞的流动，因为荧光珠的颗粒直径与癌细胞相似。手术前一天，通过内窥镜将1 ml FB注射到病变周围的粘膜下层的四个点。术中进行紫外线照射，并对提取的淋巴结进行照射以检测SN。发光淋巴结（LN）假定为SN。同时于手术时从病灶周围的浆膜侧注入SN染料（ICG）法。对25例早期胃癌患者进行SN检测。FB法SN检出率为76%（19/25）。平均SN数为2.3。FB结合ICG方法的SN检出率 ...更多信息 DS为92%（23/25）。我们根据原发肿瘤部位研究了早期癌症病例的荧光珠SN分布。上半部分1例，I室检出SN。中段14例，Ⅰ室SN检出率为76%，Ⅱ室SN检出率为24%。下半部分5例，SN位于Ⅰ室（88%）和Ⅱ室（12%）。我们发现了一例假阴性病例。在这种情况下，在SN站区域外检测到转移性淋巴结。该病例的肿瘤大小为75× 40 mm，因此，大尺寸肿瘤不适用于SN检测。早期癌症转移阳性病例仅为该假阴性病例。由于早期胃癌病例数少，FB法不能反映其准确性。此外，由于脂肪组织的自发荧光，在手术过程中难以检测隐藏在脂肪组织中的荧光LN。为使FB法更好地应用于临床，应设计一种新的紫外线照射仪器，并将FB法与其他示踪剂相结合，用于术中SN的检测。另一个需要研究的点是微转移，因为它可能有助于患者的预后。因此，我们使用抗细胞角蛋白（AE 1/AE 3）对所有切除的淋巴结，并调查25例早期胃癌的微转移。在3例病例中，我们检测到微转移。其中1例位于SN站外，采用FB和染料法联合检测。因此，我们研究微转移的存在是否对胃癌病例的预后有影响。微转移阳性与阴性之间无显著性差异。我们认为，微转移的存在并不影响预后，从这些结果来看，SN导航手术可以适用于早期GC的染料或结合FB方法与SN站淋巴结清扫。然而，FB方法的有效性不能透露，因为我们的病例数少。少