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。使用吲哚青绿和放射性同位素联合注射到肿瘤附近的胃粘膜下层，对34名患者进行了术中淋巴管标测。所有患者均行标准根治性胃切除加淋巴结清扫，并对切除的结节进行常规组织病理学检查。前哨淋巴结发现率为94.1%(32/34)。共检出87个前哨淋巴结，其中单纯染料检出24个，放射性同位素检出50个，两种方法均检出23个。6个前哨结节位于胃周区域之外。1例肌层浸润性癌患者，在胃周无放射性的绿色结节内有转移。两名晚期癌症患者有淋巴转移，但前哨淋巴结中未检测到癌细胞。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。免疫组织化学染色和磁性细胞分选均未发现前哨淋巴结微转移。我们的结果表明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种很有前途的技术，但还需要大规模的研究来建立胃癌的前哨淋巴结概念。

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.