The Trial that Used Fluorescent Beads for Sentinel Lymph Node Detection in Gastric Cancer Patients

摘要

We used the dye and fluorescent beads methods to detect sentinel lymph nodes (SN) in consenting patients with gastric cancer. All extracted lymph nodes were investigated using immunohistochemical staining with an anticytokeratin antibody (AE1/AE3) to detect micrometastasis (MM). The aim of this study was to improve SN detection through the combined use of dye and fluorescent beads, and to investigate the relationship between SN and MM. We performed SN detection on 55 gastric cancer patients: 12 patients with advanced and 43 patients with early gastric cancer. We performed immunohistochemical staining on 1808 extracted lymph nodes. The SN detection rate was 83.7% (36/43) for early gastric cancer. Using the combined ICG/fluorescent beads method, the detection rate increased to 89.4% (17/19). In four out of 10 cases, MM was found in all lymph nodes except the SN domain (SN basin). However, we encountered these cases at an early stage of our trials. In another six cases, MM was found within the SN basin. According to our results, the concept of the SN basin is quite important. A combination of the dye and fluorescent beads methods was effective in increasing the SN detection rate. It was quite difficult to detect a fluorescent lymph nodes hidden in the adipose tissue during surgery; however it was possible once the lymph nodes were extracted.