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

本研究探讨FBM检测胃癌患者前哨淋巴结(SN)的可行性。川崎医学院机构审查委员会在患者同意的情况下批准了荧光珠法(FBM)治疗胃癌(GC)。手术前一天，在内窥镜下将1ml荧光珠(FB)注射到病变周围的四个粘膜下层。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，在手术时从病变周围浆膜侧注入浆膜下层，用染料(ICG)法检测SN。在注射ICG后15分钟内，绿色结节可被认为是SN。在采样SN后，对I和II室进行淋巴清扫。对24例早期GC患者进行SN检测。FBM的SN检出率为75%(18/24例)。平均SN数为2.3个。FB结合ICG方法对SN的检出率为91.6%。单纯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，手术中很难检测到隐藏在脂肪组织中的荧光层粘连蛋白。而用紫外光照射切除提取组织可检出SN。为了将来将FB应用于临床，需要设计一种新的紫外光照射仪器来检测手术中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.