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Morphological Distribution of Metastatic Foci in Sentinel Lymph Nodes with Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The TNM classification defines micrometastasis (MM) and isolated tumor cells (ITC) in lymph nodes (LN). Sentinel node (SN) navigation surgery has been introduced in gastrointestinal cancer. Few reports have examined the morphological distribution of MM and ITC of SN in gastric cancer. The purpose of this study was to clarify the clinical significance of the morphological distribution of cancer cells in SNs according to metastasis (MA), MM, and ITC.

Methods

All dissected LNs obtained from 160 consecutive patients with mapped SNs arising from cT1–2 N0 tumors were examined. Metastasis in these LNs was examined by histology and cytokeratin staining. The distribution of MA, MM, and ITC was classified as marginal sinus (MS), intermediate sinus (IS), parenchymal (PA), and diffuse types (DF).

Results

Nodal metastases were detected in 65 SNs from 30 patients and MA, MM, and ITC accounted for 53.9%, 21.5%, and 24.6%, respectively. MS, IS, PA, and DF accounted for 57%, 6%, 17%, and 20.0%, respectively. Patients with metastasis of non-MS had more nodal metastasis in non-SNs (P = .025) and had nodal metastasis in second tier (P = .009), compared with the patients with metastasis of MS. The incidence of metastasis in non-MS was higher in tumors larger than 40 mm than those smaller than 40 mm (P = .011).

Conclusion

When performing SN navigation surgery in gastric cancer, we should keep in mind that the patients with tumor larger than 40 mm in size and nodal metastasis of non-MS may have non-SN metastasis and nodal metastasis in second tier.

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Acknowledgment

The authors thank Hidehiro Nomura, MD, Hirohki Yoshii, MD, Yuzo Kawasaki, MD, Syuichi Hokita, MD, and Tamotsu Ohsako, MD of Imamura Hospital, Shigeho Maenohara, MD and Masahiro Hamanoue, MD of Kagoshima Kouseiren Hospital as well as Takao Nitanda of Department of Pathology, Kagoshima University Hospital for valuable contributions to this study. Grant support was received from Grant-in-Aid for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan.

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Authors and Affiliations

  1. Department of Surgical Oncology and Digestive Surgery, Field of Oncology, Course of Advanced Therapeutics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Shigehiro Yanagita MD, Shoji Natsugoe MD, PhD, Yoshikazu Uenosono MD, PhD, Hideo Arima MD, Tsutomu Kozono MD, Katsuhiko Ehi MD, Takaaki Arigami MD, Hiroshi Higashi MD, PhD & Takashi Aikou MD, PhD

Authors
  1. Shigehiro Yanagita MD
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  2. Shoji Natsugoe MD, PhD
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  3. Yoshikazu Uenosono MD, PhD
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  4. Hideo Arima MD
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  5. Tsutomu Kozono MD
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  6. Katsuhiko Ehi MD
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  7. Takaaki Arigami MD
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  8. Hiroshi Higashi MD, PhD
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  9. Takashi Aikou MD, PhD
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Corresponding author

Correspondence to Shigehiro Yanagita MD.

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Yanagita, S., Natsugoe, S., Uenosono, Y. et al. Morphological Distribution of Metastatic Foci in Sentinel Lymph Nodes with Gastric Cancer. Ann Surg Oncol 15, 770–776 (2008). https://doi.org/10.1245/s10434-007-9713-0

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  • DOI: https://doi.org/10.1245/s10434-007-9713-0

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