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

本研究探讨荧光微球(FB)法检测胃癌前哨淋巴结(SN)的可行性。我们推测荧光小球可能反映了癌细胞在淋巴管中的流动，因为荧光小球的颗粒直径与癌细胞相似。在手术前一天，内窥镜将1ml 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向浆膜下层注入染料(ICG)法检测SN。对25例早期胃癌患者进行SN检测。FB法SN的检出率为76%(19/25)。平均SN数为2.3个。FB结合ICG法…检测SN的发现率更多的DS为92%(23/25)。我们调查了根据原发肿瘤部位的早期癌症患者的荧光微珠SN的分布。1例位于上段，1例见于I室，14例见于中段，见于I室(76%)、II室(24%)。下部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，转移的淋巴结被发现在SN站的区域之外。本病例肿瘤大小为75×40 mm，大肿瘤不宜作为SN检出的指征。早期癌转移阳性病例仅为这一假阴性病例。由于早期胃癌的数量较少，FB法不能揭示其准确性。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。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，在手术中检测SN，同时FB方法应与其他示踪剂相结合。另一点需要研究的是微转移，因为它可能有助于患者的预后。因此，我们对所有切除的淋巴结应用抗细胞角蛋白(AE1/AE3)，并研究了25例早期胃癌的微转移。在三个病例中，我们发现了微转移。其中1例位于SN站外，经FB和染色联合检测。因此，我们研究了微转移的存在是否会影响胃癌患者的预后。然而，我们不能认识到微转移阳性和阴性之间的显着差异。结果提示，微转移的存在不是预后不良的原因，染色或结合淋巴结清扫术可作为早期胃癌导航手术的指征。然而，由于我们的病例数量较少，FB方法的实用性还没有得到充分的体现。较少

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