Annals of Surgical Oncology

, Volume 20, Issue 7, pp 2296–2303 | Cite as

Clinical Implementations of Preoperative Computed Tomography Lymphography in Gastric Cancer: A Comparison with Dual Tracer Methods in Sentinel Node Navigation Surgery

  • Ju-Hee Lee
  • Do Joong Park
  • Young Hoon Kim
  • Cheol-Min Shin
  • Hye Seung Lee
  • Hyung-Ho Kim
Gastrointestinal Oncology



Current sentinel node (SN) detection techniques require a learning period and tracers have many disadvantages for practical use. The purpose of this study was to evaluate the feasibility of preoperative computed tomography (CT) lymphography using lipiodol for detecting SNs in gastric cancer.


A total of 24 patients who underwent laparoscopic surgery for early gastric cancer were enrolled in this study. Noncontrast CT images were obtained 1–2 h after endoscopic submucosal peritumoral injection of 1 mL of lipiodol the day before surgery. The final sentinel basins (SBs) were decided by the dual tracer method (indocyanine green plus 99mTc-antimony sulfur colloid) during laparoscopic gastrectomy. SN detection rate by preoperative CT lymphography using lipiodol and agreement between CT lymphography versus dual tracer method were evaluated. The agreement was confirmed with soft X-ray radiography of detected SBs.


Technical failure of endoscopic lipiodol injection occurred in one patient. SNs were successfully detected in the remaining 23 patients (95.8 %), whereas the intraoperative SB detection rate using the dual method was 100 %. The agreement rate, defined as the concordance between two methods or inclusion of SNs detected by CT lymphography in SBs by the dual tracer method, was 87 %.


Our initial experience of CT lymphography using lipiodol shows good potential in predicting SBs of gastric cancer preoperatively. However, SN detection by CT lymphography and the dual method should be applied complementarily in gastric cancer because discrepancies between these methods occur.


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 Seoul National University Bundang Hospital (Project No. 02-2009-013).

Conflict of interest

The authors declare no conflicts of interest.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Ju-Hee Lee
    • 1
  • Do Joong Park
    • 1
    • 2
  • Young Hoon Kim
    • 3
  • Cheol-Min Shin
    • 4
  • Hye Seung Lee
    • 5
  • Hyung-Ho Kim
    • 1
    • 2
  1. 1.Department of SurgerySeoul National University Bundang HospitalGyeonggiSouth Korea
  2. 2.Department of SurgerySeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of RadiologySeoul National University Bundang HospitalGyeonggiSouth Korea
  4. 4.Department of Internal MedicineSeoul National University Bundang HospitalGyeonggiSouth Korea
  5. 5.Department of PathologySeoul National University Bundang HospitalGyeonggiSouth Korea

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