Sentinel Node Mapping for Gastric Cancer: A Prospective Multicenter Trial in Japan

作者：Yuko Kitagawa, Hiroya Takeuchi, Yu Takagi, Shoji Natsugoe, Masanori Terashima, Nozomu Murakami, Takashi Fujimura, Hironori Tsujimoto, Hideki Hayashi, Nobunari Yoshimizu, Akinori Takagane, Yasuhiko Mohri, Kazuhito Nabeshima, Yoshikazu Uenosono, Shinichi Kinami, Junichi Sakamoto, Satoshi Morita, Takashi Aikou, Koichi Miwa, Masaki Kitajima · 发表于：Journal of Clinical Oncology · 年份：2013 · DOI：10.1200/jco.2013.50.3789 · 被引用次数：339 · 研究领域：Gastric Cancer Management and Outcomes、Esophageal Cancer Research and Treatment、Gastrointestinal Tumor Research and Treatment

PURPOSE: Complicated gastric lymphatic drainage potentially undermines the utility of sentinel node (SN) biopsy in patients with gastric cancer. Encouraged by several favorable single-institution reports, we conducted a multicenter, single-arm, phase II study of SN mapping that used a standardized dual tracer endoscopic injection technique. PATIENTS AND METHODS: Patients with previously untreated cT1 or cT2 gastric adenocarcinomas < 4 cm in gross diameter were eligible for inclusion in this study. SN mapping was performed by using a standardized dual tracer endoscopic injection technique. Following biopsy of the identified SNs, mandatory comprehensive D2 or modified D2 gastrectomy was performed according to current Japanese Gastric Cancer Association guidelines. RESULTS: Among 433 patients who gave preoperative consent, 397 were deemed eligible on the basis of surgical findings. SN biopsy was performed in all patients, and the SN detection rate was 97.5% (387 of 397). Of 57 patients with lymph node metastasis by conventional hematoxylin and eosin staining, 93% (53 of 57) had positive SNs, and the accuracy of nodal evaluation for metastasis was 99% (383 of 387). Only four false-negative SN biopsies were observed, and pathologic analysis revealed that three of those biopsies were pT2 or tumors > 4 cm. We observed no serious adverse effects related to endoscopic tracer injection or the SN mapping procedure. CONCLUSION: The endoscopic dual tracer method for SN biopsy was confirme...