Annals of Surgical Oncology

, Volume 18, Issue 1, pp 160–165 | Cite as

Simultaneous Indocyanine Green and 99mTc-Antimony Sulfur Colloid-Guided Laparoscopic Sentinel Basin Dissection for Gastric Cancer

  • Do Joong Park
  • Hyung-Ho Kim
  • Young Soo Park
  • Hye Seung Lee
  • Won Woo Lee
  • Hyuk-Joon Lee
  • Han-Kwang Yang
Gastrointestinal Oncology



There are few reports on a dual dye and isotope approach using laparoscopy in gastric cancer sentinel node mapping. The aim of this study is to evaluate the feasibility of laparoscopic sentinel basin dissection for gastric cancer using simultaneous indocyanine green (ICG) and 99mTc-antimony sulfur colloid (ASC) injections.


Sixty-eight patients were enrolled who had been diagnosed with cT1–T2 and cN0 stage gastric cancers. They underwent laparoscopic sentinel basin dissection between June 2005 and May 2008. ICG and 99mTc-tin colloid (separate injections in the first phase, n = 16) or ICG and 99mTc-ASC (simultaneous injections in the second phase, n = 52) were injected into the submucosa endoscopically. After performing the sentinel basin dissection, laparoscopy-assisted gastrectomy with curative lymphadenectomy was done. Green-stained or radioactive sentinel nodes (SNs) were analyzed by hematoxylin and eosin staining and by immunohistochemistry for cytokeratin.


SNs were identified in 62 of the 68 patients (91.2%; mean 3.3 per patient). Eighteen patients had lymph node metastases. The sensitivity and specificity were, respectively, 72.2 and 100% using the dye method and 83.3 and 100% by the isotope method. However, the dual dye/isotope procedure improved both sensitivity and specificity to 100%. Patients receiving this protocol had significantly more SNs than those receiving separate ICG and 99mTc-tin colloid injections (3.3 vs. 1.9, P = 0.008).


Simultaneous ICG and 99mTc-ASC-guided laparoscopic sentinel basin dissection is an effective tool for gastric cancer SN mapping, giving a high detection rate and excellent sensitivity.


Gastric Cancer Sentinel Node Sentinel Node Biopsy Early Gastric Cancer Sentinel Node Mapping 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare, and Family Affairs, Republic of Korea (A085125).


  1. 1.
    Kim JP, Lee JH, Kim SJ, et al. Clinicopathologic characteristics and prognostic factors in 10,783 patients with gastric cancer. Gastric Cancer. 1998;1:125–33.CrossRefPubMedGoogle Scholar
  2. 2.
    Lee HJ, Yang HK, Ahn YO. Gastric cancer in Korea. Gastric Cancer. 2002;5:177–82.CrossRefPubMedGoogle Scholar
  3. 3.
    Ahn HS, Lee HJ, Yoo MW, et al. Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer. J Surg Oncol. 2009;99:20–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group. Ann Surg. 1999;230:453–63.CrossRefPubMedGoogle Scholar
  5. 5.
    Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–401.CrossRefPubMedGoogle Scholar
  6. 6.
    Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546–53.CrossRefPubMedGoogle Scholar
  7. 7.
    Hiratsuka M, Miyashiro I, Ishikawa O, et al. Application of sentinel node biopsy to gastric cancer surgery. Surgery. 2001;129:335–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Kitagawa Y, Fujii H, Mukai M, et al. Radioguided sentinel node detection for gastric cancer. Br J Surg. 2002;89:604–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Hayashi H, Ochiai T, Mori M, et al. Sentinel lymph node mapping for gastric cancer using a dual procedure with dye- and gamma probe-guided techniques. J Am Coll Surg. 2003;196:68–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Kim MC, Kim HH, Jung GJ, et al. Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer. Ann Surg. 2004;239:383–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Park DJ, Lee HJ, Lee HS, et al. Sentinel node biopsy for cT1 and cT2a gastric cancer. Eur J Surg Oncol. 2006;32:48–54.CrossRefPubMedGoogle Scholar
  12. 12.
    Kitano S, Shiraishi N, Uyama I, et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245:68–72.CrossRefPubMedGoogle Scholar
  13. 13.
    Kim W, Song KY, Lee HJ, et al. The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg. 2008;248:793–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Kitagawa Y, Ohgami M, Fujii H, et al. Laparoscopic detection of sentinel lymph nodes in gastrointestinal cancer: a novel and minimally invasive approach. Ann Surg Oncol. 2001;8:86S–9S.PubMedGoogle Scholar
  15. 15.
    Tonouchi H, Mohri Y, Tanaka K, et al. Laparoscopic lymphatic mapping and sentinel node biopsies for early-stage gastric cancer: the cause of false negativity. World J Surg. 2005;29:418–21.CrossRefPubMedGoogle Scholar
  16. 16.
    Japanese Gastric Cancer Association. Japanese Classification of gastric carcinoma. Gastric Cancer. 1998;1:10–24 (2nd English Edition).CrossRefPubMedGoogle Scholar
  17. 17.
    Jeong JM, Hong MK, Kim YJ, et al. Development of 99mTc-neomannosyl human serum albumin (99mTc-MSA) as a novel receptor binding agent for sentinel lymph node imaging. Nucl Med Commun. 2004;25:1211–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Henze E, Schelbert HR, Collins JD, et al. Lymphoscintigraphy with Tc-99m-labeled dextran. J Nucl Med. 1982;23:923–9.PubMedGoogle Scholar
  19. 19.
    Nimura H, Narimiya N, Mitsumori N, et al. Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg. 2004;91:575–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Tajima Y, Yamazaki K, Masuda Y, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer. Ann Surg. 2009;249:58–62.CrossRefPubMedGoogle Scholar
  21. 21.
    Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A. Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg. 2003;90:178–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Lee YJ, Ha WS, Park ST, et al. Which biopsy method is more suitable between a basin dissection and pick-up biopsy for sentinel nodes in laparoscopic sentinel-node navigation surgery (LSNNS) for gastric cancer? J Laparoendosc Adv Surg Tech A. 2008;18:357–63.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Do Joong Park
    • 1
  • Hyung-Ho Kim
    • 1
  • Young Soo Park
    • 2
  • Hye Seung Lee
    • 3
  • Won Woo Lee
    • 4
  • Hyuk-Joon Lee
    • 5
  • Han-Kwang Yang
    • 5
  1. 1.Department of Surgery, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamKorea
  2. 2.Department of Internal MedicineSeoul National University Bundang HospitalSeongnamKorea
  3. 3.Department of PathologySeoul National University Bundang HospitalSeongnamKorea
  4. 4.Department of Nuclear MedicineSeoul National University Bundang HospitalSeongnamKorea
  5. 5.Department of SurgerySeoul National University HospitalSeoulKorea

Personalised recommendations