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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

Abstract

Background

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.

Methods

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.

Results

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 %.

Conclusions

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.

Keywords

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.

Notes

Acknowledgment

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.

References

  1. 1.
    Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol. 1997;15:2345–50.PubMedGoogle Scholar
  2. 2.
    Veronesi U, Paganelli G, Galimberti V, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes. Lancet. 1997;349:1864–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Bass SS, Cox CE, Ku NN, Berman C, Reintgen DS. The role of sentinel lymph node biopsy in breast cancer. J Am Coll Surg. 1999;189:183–94.PubMedCrossRefGoogle Scholar
  4. 4.
    Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995;82:346–351.PubMedCrossRefGoogle Scholar
  5. 5.
    Kosaka T, Ueshige N, Sugaya J, et al. Lymphatic routes of the stomach demonstrated by gastric carcinomas with solitary lymph node metastasis. Surg Today. 1999;29:695–700.PubMedCrossRefGoogle Scholar
  6. 6.
    Bembenek A, Gretschel S, Schlag PM. Sentinel lymph node biopsy for gastrointestinal cancers. J Surg Oncol. 2007;96:342–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Schlag PM, Bembenek A, Schulze T. Sentinel node biopsy in gastrointestinal-tract cancer. Eur J Cancer. 2004;40(14):2022–32.PubMedCrossRefGoogle Scholar
  8. 8.
    Hyung WJ, Kim YS, Lim JS, Kim MJ, Noh SH, Kim KW. Preoperative imaging of sentinel lymph nodes in gastric cancer using CT lymphography. Yonsei Med J. 2010;51(3):407–13.PubMedCrossRefGoogle Scholar
  9. 9.
    Tsujimoto H, Yaguchi Y, Sakamoto N, et al. Computed tomography lymphography for the detection of sentinel nodes in patients with gastric carcinoma. Cancer Sci. 2010;101(12):2586–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Tangoku A, Yamamoto S, Suga K, et al. Sentinel lymph node biopsy using computed tomography—lymphography in patients with breast cancer. Surgery. 2004;135:258–65.PubMedCrossRefGoogle Scholar
  11. 11.
    Minohata J, Takao S, Hirokaga K. Sentinel lymph node biopsy using CT lymphography in breast cancer. Breast Cancer. 2011;18:129–36.PubMedCrossRefGoogle Scholar
  12. 12.
    Park do J, Kim HH, Park YS, Lee HS, Lee WW, Lee HJ, Yang HK. Simultaneous indocyanine green and (99m)Tc-antimony sulfur colloid-guided laparoscopic sentinel basin dissection for gastric cancer. Ann Surg Oncol. 2011;18(1):160–5. Epub 2010 Jul 21.PubMedCrossRefGoogle Scholar
  13. 13.
    Lee HS, Lee HE, Park do J, Park YS, Kim HH. Precise pathologic examination decreases the false-negative rate of sentinel lymph node biopsy in gastric cancer. Ann Surg Oncol. 2012;19(3):772–8. Epub 2011 Oct 7.PubMedCrossRefGoogle Scholar
  14. 14.
    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(1):68–74.PubMedCrossRefGoogle Scholar
  15. 15.
    Saikawa Y, Otani Y, Kitagawa Y, et al. Interim results of sentinel node biopsy during laparoscopic gastrectomy: possible role in function-preserving surgery for early cancer. World J Surg. 2006;30(11):1962–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Japanese Gastric Cancer A. Japanese classification of gastric carcinoma, 2nd English edn. Gastric Cancer. 1998;1:10–24.CrossRefGoogle Scholar
  17. 17.
    Hwang SH, Kim HH, Park do J, et al. Local tissue reaction after injection of contrast media on gastric wall of mouse: experimental study for application of contrast media to computed tomography lymphography. J Korean Surg Soc. 2012;82:70–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Chung YE, Hyung WJ, Kweon S, et al. Feasibility of interstitial CT lymphography using optimized iodized oil emulsion in rats. Invest Radiol. 2010;45(3):142–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Kos S, Haueisen H, Lachmund U, Roeren T. Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage. Cardiovasc Intervent Radiol. 2007;30:968–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Kusumoto S, Imamura A, Watanabe K. Case report: the incidental lipid embolization to the brain and kidney after lymphography in a patient with malignant lymphoma: CT findings. Clin Radiol. 1991;44:279–80.PubMedCrossRefGoogle Scholar
  21. 21.
    Lim JS, Choi J, Song J, Chung YE, Lim SJ, Lee SK, Hyung WJ. Nanoscale iodized oil emulsion: a useful tracer for pretreatment sentinel node detection using CT lymphography in a normal canine gastric model. Surg Endosc. 2012;26:2267–74.PubMedCrossRefGoogle Scholar
  22. 22.
    Choi JY, Jeong JM, Yoo BC, et al. Development of 68 Ga-labeled mannosylated human serum albumin (MSA) as a lymph node imaging agent for positron emission tomography. Nucl Med Biol. 2011;38:371–9.PubMedCrossRefGoogle Scholar

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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