Current status of sentinel lymph node biopsy in adenocarcinoma of the distal esophagus, gastric cardia, and proximal stomach

Status and prognosis of lymph node metastasis in patients with cardia cancer - a systematic review

BACKGROUND

Adenocarcinoma of the gastroesophageal junction (GEJ) has a poor prognosis and survival rates significantly decreases if lymph node metastasis is present. An extensive lymphadenectomy may increase chances of cure, but may also lead to further postoperative morbidity and mortality. Therefore, the optimal treatment of cardia cancer remains controversial. A systematic review of English publications dealing with adenocarcinoma of the cardia was conducted to elucidate patterns of nodal spread and prognostic implications.

METHODS

A systematic literature search based on PRISMA guidelines identifying relevant studies describing lymph node metastasis and the associated prognosis. Lymph node stations were classified according to the Japanese Gastric Cancer Association guidelines.

RESULTS

The highest incidence of metastasis is seen in the nearest regional lymph nodes, station no. 1-3 and additionally in no. 7, 9 and 11. Correspondingly the best survival is seen when metastasis remain in the most locoregional nodes and survival equally tends to decrease as the metastasis become more distant. Furthermore, the presence of lymph node metastasis significantly correlates to the TNM-stage. Incidences of metastasis in mediastinal lymph nodes are associated with poor survival.

CONCLUSION

The best survival rates is seen when lymph node metastasis remains locoregional and survival rates decreases when distant lymph node metastasis is present. The dissection of locoregional lymph nodes offers significantly therapeutic benefit, but larger and prospective studies are needed to evaluate the effect of dissecting distant and mediastinal lymph nodes.

Nanoscale iodized oil emulsion: a useful tracer for pretreatment sentinel node detection using CT lymphography in a normal canine gastric model

BACKGROUND

Pretreatment identification of the sentinel lymph nodes (SLNs) in gastric cancer patients may have great advantages for minimally invasive treatment. No reliable method for the detection of SLNs during the pretreatment period in gastric cancer has been established. The aim of this study was to determine whether computed tomographic (CT) lymphography using nanoscale iodized oil emulsion via endoscopic submucosal injection can visualize LNs.

METHODS

Five dogs underwent CT lymphography after endoscopic submucosal injection of 2 ml of a nanoscale iodized oil emulsion. CT images were taken before and 30, 90, and 210 min after contrast injection. Intraoperative SLN detection was performed using endoscopically injected indocyanine green lymphography for comparison.

RESULTS

Computed tomographic lymphography with nanoscale iodized oil emulsion enabled the visualization of 19 enhanced LNs (mean = 3.8/dog, range = 3-6) with a 100% SLN detection rate. The locations of the SLNs were the lesser curvature (n = 7), greater curvature (n = 1), infrapyloric (n = 3), and left gastric (n = 8) areas. Contrast enhancement of SLNs continuously increased and peaked after 210 min at 142.4 ± 42.3 HU. No green LNs were visualized in the three locations that were detected by CT lymphography. However, no additional LNs were visualized using the dye method. The concordance rate based on the LNs between the SLNs on CT lymphography and the green LNs using the ICG method was 84% (16/19), whereas the concordance rate of the stations identified by CT lymphography and the dye method was 78.6% (11/14).

CONCLUSIONS

Computed tomographic lymphography using nanoscale iodized oil emulsion is a promising tool for preoperative SLN detection for early gastric cancer if the biological safety of the nanoscale iodized oil emulsion can be established.