胃癌细胞增殖活性与淋巴结转移关系的研究

目的　探讨溴化脱氧脲嘧啶核苷 (BrdUrd) /DNA双参数流式细胞术 (FCM )检测胃癌的价值 ,研究胃癌细胞BrdUrd标记指数 (LI) ,G2 /M期细胞比率 (G2 /MPF)和DNA含量与胃癌淋巴结转移的关系。方法　 60例胃癌新鲜标本 ,用BrdUrd/DNA双参数流式细胞术进行检测。结果淋巴结阳性者 ,BrdurdLI明显增高 (P <0 .0 1,P =0 .0 0 0 5 8) ,G2 /MPF明显增高 (P <0 .0 1,P =0 .0 0 2 70 )。淋巴结转移个数大于 5枚者 ,BrdUrdLI较无转移者明显增高 (P <0 .0 1,P =6.43E 0 5 ) ,较转移 1～ 4枚者明显增高 (P <0 .0 5 ,P =0 .0 43 10 ) ,G2 /MPF较无转移者明显增高(P <0 .0 5 ,P =0 .0 0 840 ) ;淋巴结转移 1～ 4枚者 ,G2 /MPF较无转移者明显增高 (P <0 .0 5 ,P =0 .0 160 0 )。淋巴结转移第Ⅱ站以远者 ,BrdurdLI较无转移者明显增高 (P <0 .0 1,P =0 .0 0 13 2 ) ,G2 /MPF较无转移者明显增高 (P <0 .0 1,P =0 .0 0 13 0 ) ;淋巴结转移第Ⅰ站者 ,G2 /MPF较无转移者明显增高 (P <0 .0 1,P =0 .0 0 718) ,异倍体癌淋巴结阳性者明显增多 (P <0 .0 5 ,χ2 =5 .71)。结论　胃癌细胞BrdUrdLI、G2 /MPF和DNA含量与淋巴结转移及转移数量和距离有关。     

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目的 研究胃上部癌腹腔淋巴结转移规律及其在外科治疗中的意义。方法 回顾性调查施行根治手术并具有完整临床病理资料的胃上部癌病例，分析各组、站淋巴结转移的频度及其与胃癌浸润深度的关系，并比较不同淋巴结分级的术后5年生存率。结果 pT2淋巴结转移阳性病例占81％，其中N1为44％、N2为37％；pT3淋巴结转移占83％，N1为30％、N2为40％、N3为13％；而pT4则100％发生淋巴结转移。幽门上、下组（N3）转移率达9％。不同转移淋巴结分级间术后5年生存率差异有显著性。结论 进展期胃上部癌应行D2以上的淋巴结清除术，方能达到根治的目的。     

根治性淋巴结清扫联合脾切除在残胃癌手术中的临床意义探究

目的阐明淋巴结清扫与脾切除在残胃癌手术中的重要性。方法远端残胃癌患者63例,行D_2行淋巴结切除23例,非D_2淋巴结切除40例,并行脾切除30例,未行脾切除33例。观察患者的术后总体生存率,分析残胃癌患者全胃切除术后临床病理特征、手术治疗和长期预后。结果D_2淋巴结清扫术和非D_2淋巴结清扫术切除淋巴结的平均数量分别为(16.5±1.5)枚和(7.7±1.4)枚,两者比较差异有统计学意义(P0.01);pT1/pT2肿瘤患者脾门区域无淋巴结转移,pT3/pT4肿瘤患者发生淋巴结转移4例;浸润深度为pT3/pT4肿瘤患者切脾组生存率高于保脾组(P0.01),而pT1/pT2肿瘤患者差异无统计学意义(P0.05);浸润深度为pT3/pT4肿瘤患者D_2淋巴清扫术组生存率高于非D_2组(P0.01),而pT1/pT2肿瘤患者则无明显差异(P0.05)。结论根治性淋巴结清扫与脾切除对晚期(pT3/pT4)残胃癌患者有益。     

胃癌单个淋巴结转移规律及临床意义

目的分析胃癌淋巴结转移的规律以指导临床规范化治疗。方法对天津医科大学附属肿瘤医院1999年7月至2004年6月间经手术治疗、清扫淋巴结数大于或等于10枚、术后病理证实仅有1枚淋巴结转移的胃癌患者临床资料进行回顾性分析．并对淋巴结跳跃与非跳跃转移、横向与非横向转移患者的资料进行对比。结果全组65例患者共检出淋巴结1415枚．平均21．8枚／例;单个淋巴结转移率的分布从多到少依次为N0．3（30．8％）、No．4（21．5％）、No．6（15．4％）、No．7和No．8（均为6．2％）、No．1和No．2及N0．5（均为4．6％）、No．12（3．1％）和No．14及No．16（均为1．5％）;其中跳跃转移20．0％（13／65）,横向转移42．2％（19／45）。单因素分析显示．淋巴结跳跃性转移仅与肿瘤大小有关（X2=4．447,P=0．035）：淋巴结横向转移与各临床病理因素均无关。但淋巴结跳跃与非跳跃转移、横向与非横向转移间患者的生存曲线差异有统计学意义（P=0．000．P=0．000）。结论胃癌淋巴结转移规律总体遵循由远及近的转移顺序．但跳跃转移和横向转移方式也占有一定比例．对于胃癌淋巴结跳跃转移和横向转移的高危患者．术中应加强相应区域淋巴结清扫以提高患者生存率。     

转移性胃癌的转化治疗

目的探讨转移性胃癌的临床病理特征及转化治疗效果。方法回顾性分析2018年1月至2021年6月北京大学人民医院胃肠外科确诊并治疗的31例转移性胃癌患者的临床病理及随访资料。采用多因素Logistic回归分析病理完全缓解与临床病理特征的相关因素, 并用Kaplan-Meier生存曲线分析转移性胃癌分型与术后病理缓解程度对患者预后的影响。结果本组31例患者中肿瘤位于贲门胃底部13例, 胃体部8例, 幽门胃窦部10例。有10例术前影像学评价为腹膜后淋巴结转移, 腹腔种植转移10例, 肝转移2例, 肾上腺和脾转移各1例, 多发转移5例。转化治疗术后病理有8例(26%)原发灶完全缓解(pT0), 16例(52%)区域淋巴结完全缓解(pN0), 7例(22%)病理完全缓解。多因素Logistic回归分析显示, 腹膜后淋巴结转移(OR:20.082, 95%CI:2.141～188.315, P=0.009)是病理完全缓解的独立影响因素。pT0可以显著改善无疾病生存时间(P=0.021)。结论转移性胃癌中单纯腹膜后淋巴结转移患者的转化治疗效果较好, pT0是改善患者预后的重要因素。     

胃癌单枚淋巴结转移的影响因素分析

目的 探讨接受胃癌D₂根治术病人单枚淋巴结转移的发生率及相关影响因素。方法 回顾性分析2012年1月至2022年6月武汉市第一医院及浠水县人民医院连续2 258例胃癌术后病人的临床病理资料。计算单枚淋巴结转移发生率,并对单枚淋巴结转移的相关影响因素进行Logistic回归分析。结果 2 258例原发性胃癌病例中,纳入507例无淋巴结转移病例及123例单枚淋巴结转移病例,单枚淋巴结转移发生率为5.45%。单枚淋巴结转移病例与无淋巴结转移病例在肿瘤大小、美国癌症联合委员会(AJCC)-pT分期、脉管癌栓和淋巴结检查数目方面的差异均有统计学意义(均P<0.05),两组病例在性别、年龄、肿瘤部位、分化程度和Lauren组织类型方面的差异均无统计学意义(均P>0.05)。单因素分析结果显示：肿瘤大小(P=0.013)、脉管癌栓(P<0.001)、AJCC-pT分期(P<0.001)和淋巴结检查数目(≥30枚,P=0.002)与胃癌单枚淋巴结转移显著相关;多因素分析显示：脉管癌栓(P=0.002)、pT分期(P<0.001)和淋巴结检查数目(≥3...     

pT1～3N0期胃癌淋巴结微转移检测的临床意义

目的 研究淋巴结微转移及临床病理因素对pT1～3N0期胃癌患者术后5年无瘤生存率的影响.方法 纳入我院2000年1月至2004年12月期间pT1～3N0期胃癌患者行根治术者120例2 106枚淋巴结,每例患者淋巴结9～28枚,平均18枚,所有淋巴结经HE染色均为阴性.应用免疫组化染色法检测淋巴结中CK20表达,并分析胃癌患者的临床病理特征及胃癌淋巴结中CK20表达对5年无瘤生存率的影响.结果 经免疫组化染色,有9.07%(191/2 106)的淋巴结出现CK20阳性表达;有26.67%(32/120)患者的淋巴结中出现CK20阳性表达,其中11例(9.17%)为微转移,21例(17.50%)为孤立肿瘤细胞巢(ITC).术后随访24～121个月(平均66.35个月).淋巴结中CK20阴性表达、ITC和微转移的患者,5年无瘤生存率分别为87.4%、78.3%和40.9%.5年无瘤生存率在淋巴结CK20出现微转移者中明显低于CK20阴性表达者(P＝0.000)和以ITC为特征者(P＝0.046),而仅以ITC为特征者与CK20阴性表达者间比较,差异无统计学意义(P＝0.253).淋巴结中CK20阳性表达与胃癌患者的肿瘤直径(P＝0.011)、浸润胃壁深度(P＝0.043)和是否有淋巴管浸润(P＝0.002)有关.所有临床病理因素对5年无瘤生存率均无明显影响(P>0.05).11例胃癌患者被检测出微转移,应划分为pN1(Mi)期,本组重新分期率9.17%.而88例胃癌患者淋巴结CK20(-)和21例表达为ITC,分别被记为pN0(I-)和pN0(I+),不建议重新分期,仍为pN0期.结论 对于pT1～3N0期胃癌,若淋巴结中检测出微转移,其预后较差,术后5年无瘤生存率较低,建议术后应予以积极的辅助治疗.     

胃癌单个淋巴结转移规律及其临床价值

目的:探讨胃癌单个淋巴结转移的规律及其临床价值,为进一步前瞻性检测胃癌前哨淋巴结并指导胃癌淋巴结清扫范围提供理论依据.方法:回顾性分析59例发生单个淋巴结转移的胃癌病例的临床病理资料,以求探明单个淋巴结转移的出现部位及其与原发病灶的关系,比较跳跃性淋巴结转移和非跳跃性淋巴结转移两组间的临床病理特征及预后差异.结果:本组非跳跃性淋巴结转移发生率为88.1%,跳跃性淋巴结转移发生率为11.9%.胃下部癌的淋巴结转移以第6组最为常见.与非跳跃性淋巴结转移组相比,跳跃性淋巴结转移仅与肿瘤大小有显著相关性.两组平均生存时间与5年生存率之间差异均无统计学意义.结论:胃癌单个淋巴结转移以胃周为主.跳跃性淋巴结转移与肿瘤大小有关.胃癌D2根治术有利于清扫跳跃性淋巴结转移灶.前哨淋巴结活检技术在胃癌手术治疗中可能具有一定的意义.     

胃癌孤立性淋巴结转移规律及其预后分析

目的 探讨胃癌孤立性淋巴结转移的规律及其预后.方法 回顾性分析1995年1月至2003年12月期间83例接受D2根治术的胃癌孤立性淋巴结转移患者的临床资料,探讨胃癌孤立性淋巴结转移发生的部位及其与原发病灶的关系;比较跳跃性与非跳跃性淋巴结转移患者的预后差异;对本组患者的预后因素进行单因素及多因素分析.结果 本组83例胃癌孤立性淋巴结转移患者中,第1站淋巴结转移者64例(77%),直接发生第2站淋巴结转移(跳跃性转移)者19例(23%),胃上、中、下部癌分别以No.3(40%)、No.3(42%)、No.6组(33%)淋巴结转移最为常见.本组77例(93%)患者获得随访,时间5～14年,其中位生存期为77.0个月,术后5年生存率为63%;跳跃性与非跳跃性淋巴结转移患者术后5年生存率分别为52%和67%,两者差异无统计学意义(P＞0.05).影响本组患者预后的相关因素是浆膜是否受侵和肿瘤病理类型,其中浆膜是否受侵为影响预后的独立因素.结论 第1站淋巴结是胃癌孤立性淋巴结转移的主要部位,可以作为胃癌前哨淋巴结导航外科中淋巴绘图的主要目标;肿瘤侵犯浆膜层的胃癌孤立性淋巴结转移的患者预后较差.     

颈部超声评价胸段食管癌颈部淋巴结转移

目的　探讨提高胸段食管癌颈部淋巴结转移诊断正确率的方法。　方法　 42例胸段食管鳞癌患者 ,术前行双侧颈部超声检查 ,转移淋巴结判定标准包括淋巴结的大小 (长径≥ 1 0mm)和形态 (短径 /长径 >0 5)。　结果　术前超声发现颈部淋巴结肿大 (短径≥ 5mm) 1 6例 ,触诊可扪及 5例。其中根据超声检查结果 9例判定为转移淋巴结 (cM1 LN) ,触诊可扪及 4例。本组 5例无法行肿瘤根治性切除者行非手术治疗 ;37例手术切除肿瘤的患者中 ,术后病理证实 6例颈部淋巴结转移(pM1 LN) ,其中 4例肿瘤侵犯食管外膜 (pT3)、2例术中发现肿瘤外侵 (pT4 ) ,并且均同时伴纵隔淋巴结转移 ,其中 4例还伴有腹腔淋巴结转移 ;1 1例pT1 、pT2 患者中无一例发现颈部淋巴结转移 (P =0 0 2 0 )。根据病理及临床治疗结果 ,超声判定颈部淋巴结转移的准确率显著高于触诊 (40 / 4 2 ,95 %比34/ 4 2 ,81 % ,P =0 0 4 3) ,敏感性亦明显高于触诊 (82 %比 36 % ,P =0 0 81 )。全组病例中 ,有 5例 (5/ 39,1 3 % )因颈部超声检查结果而改变治疗方式。　结论　超声检查判断颈部淋巴结转移的敏感性及准确率明显高于体检触诊 ,有助于提高食管癌术前分期的准确性     

Zur Methodik des Sentinel Lymph Node Mapping

Sentinel lymph node mapping is used as a diagnostic method in order to increase staging accuracy without the well-known morbidities of radical lymphadenectomy. The sentinel node is defined as the first node to receive lymphatic drainage from a primary tumor. The sentinel node concept postulates that if the first draining node is negative for metastasis, the remaining lymph nodes in the nodal basin can be spared. Thus one can predict the status of the nodal basin with high accuracy. It also shows that lymphatic spread seems to follow certain rules that do not concern the whole lymphatic basin. Skip metastases were proven to be rare in breast and gastric cancer. The main issue in sentinel lymph node mapping remains the improvement of staging accuracy for detection of lymph nodes most likely to develop metastasis as well as reducing morbidity by planning lymphadenectomies individually for each tumor and each patient.     

Investigation of the Lymphatic Stream of the Stomach in Gastric Cancer with Solitary Lymph Node Metastasis

Background  Understanding the lymphatic drainage route in gastric cancer is crucial for complete lymph node retrieval from sites susceptible to metastasis. However, the lymphatic stream of the stomach is complex and remains incompletely characterized. Methods  Patients with small (<4 cm) serosa-negative gastric cancer with solitary lymph node metastasis treated at the Cancer Institute Hospital were included in this study. A total of 135 patients were classified according to the location of the solitary lymph node metastasis into the left gastric artery (LGA) group, the right gastroepiploic artery (RGEA) group, the right gastric artery (RGA) group, or the splenic artery (SA) group. The location of the primary tumors was investigated to aid the mapping of the lymphatic stream of the stomach. Results  Lymphatic flow in LGA (65 patients) and in RGEA (57 patients) are main lymphatic drainage routes of the stomach. The lymphatic area overlapped in the lower third of the stomach in LGA and RGEA, and the lymphatic flow associated with gastric cancer located within this overlapped area can be multidirectional. Skip metastases were observed in 13 patients (10%), and all skip metastases were observed in the suprapancreatic area (station 7, 8a, 9, or 11p). Conclusions  The lymphatic stream of the stomach is complicated and multidirectional. Understanding and mapping the complex lymphatic streams of the stomach will allow surgeons to perform more effective lymph node dissection during gastric cancer surgery.     

Appropriate lymph node dissection for early gastric cancer based on lymph node metastases

BACKGROUND: Lymph node dissection in patients with early gastric cancer is controversial because lymph node metastases are much less common than in advanced cancer. Therefore, routine extensive lymph node dissection with wide resection of the stomach may be excessive, and an appropriate lymph node dissection procedure in patients with early gastric cancer should be established. METHODS: Retrospectively, 588 consecutive patients with early gastric cancer were analyzed by univariate and multivariate analysis to predict lymph node metastases with clinicopathologic variables. The sites and rates of lymph node metastases for each tumor location were mapped. RESULTS: In early gastric cancer, depth of invasion was an independent predictive factor of lymph node metastases. In cancer confined to the mucosa, however, tumor diameter was the only predictive factor. In contrast, tumor diameter, macroscopic appearance, and histologic type were not predictive factors in early gastric cancers invading the submucosa. In mucosal cancer, metastasis to lymph nodes was confined to the paragastric lymph nodes on the same side of the stomach as the tumor. In submucosal cancer, the incidence of lymph node metastasis was 2% to 17% in group 1 and 1% to 3% in group 2 lymph nodes. CONCLUSIONS: In mucosal cancer, lymph node dissection is unnecessary for tumors measuring less than 30 mm, and limited lymph node dissection with local gastrectomy is appropriate when tumor diameters are 30 mm or greater. In submucosal cancer, gastrectomy with dissection of group 1 and some group 2 lymph nodes should be sufficient to remove all nodal metastases.     

Sentinel node mapping during laparoscopic distal gastrectomy for gastric cancer

Background The goal of this study was to evaluate the feasibility and accuracy of sentinel node (SN) mapping with endoscopic submucosal blue dye injection during laparoscopic distal gastrectomy for gastric cancer. Methods Thirty-four patients affected by gastric adenocarcinoma without gross clinical serosal invasion and distant metastasis were prospectively enrolled. At the start of the surgery, 2 ml of 2% patent blue was endoscopically injected into the submucosal layer at four points around the site of the primary tumor. Sentinel nodes were defined as nodes that were stained by the blue dye within 5–10 min after the dye injection. After identification and removal of sentinel lymph nodes, each patient underwent laparoscopic distal gastrectomy with D1 (n = 2) or D2 (n = 32) lymphadenectomy. Results Of the 34 patients, 14 had positive nodules (41%). SNs were detectable as blue nodes in 27 (80%) of 34 patients. The mean number of dissected lymph nodes per patient was 31 ± 10 (range = 16–64) and the mean number of blue nodes was 1.5 (range = 1–4). Only five (sensitivity 36%) of 14 N(+) patients had at least one metastatic lymph node among the SNs identified. In these 14 patients the sentinel node was traced in 12 cases. Sentinel node status diagnosed the lymph node status with 74% accuracy. In early gastric cancer (n = 18), three patients had lymph node metastasis. These early gastric cancer patients with nodal metastases had at least one metastatic lymph node among the SNs identified (sensitivity 100%). Conclusions Blue dye SN mapping during laparoscopic distal gastrectomy seems to be a feasible and accurate diagnostic tool for detecting lymph node metastasis in patients with early-stage gastric cancer in which the accuracy of the method was 100%. However, in more advanced gastric cancer the results are not satisfactory. Validation of this method requires further studies on technical issues, including selection of the tracers.     

Lymphatic mapping and sentinel node biopsy in gastric cancer

BACKGROUND: To determine the feasibility and significance of lymphatic mapping and sentinel lymph node biopsy (SLNB) in patients with gastric cancer. METHODS: From August 1999 to January 2002, 27 gastric cancer patients underwent lymphatic mapping and sentinel lymph node biopsy using isosulfan blue dye. RESULTS: The success rate of SLNB was 96.3% (26 of 27). Accuracy, sensitivity, and specificity were 100%. There were no false negatives. In 26 successful cases, 8 patients had positive sentinel lymph nodes and 18 had negative sentinel nodes. Of 8 patients with positive sentinel nodes, 6 had positive sentinel nodes only at N1 lymph node station, 1 only at N2 station, and 1 had positive sentinel nodes at both N1 and N2 stations. Of 18 patients with negative sentinel lymph nodes, 9 patients had sentinel nodes only at N1, 3 only at N2, 5 at both N1 and N2, and 1 at both N1 and N3. There were no cases in which sentinel lymph nodes were the only sites of metastases. CONCLUSIONS: Sentinel lymph node biopsy using isosulfan blue dye in gastric cancer is a feasible procedure with high sensitivity and accuracy. Sentinel lymph nodes demonstrate the varied lymphatic drainage. If the sentinel nodes at N2 are positive, it will guide surgeons to do a more extended lymph node dissection in early stage gastric cancer.     

胃癌前哨淋巴结临床意义的研究

目的 观察胃癌前哨淋巴结的分布，探讨其临床意义。方法 回顾性分析288例胃癌前哨淋巴结术中染色后显影的范围及特征。术中向肿瘤边缘的正常胃壁浆膜下肌层、黏膜下层注射亚甲蓝，观察淋巴结显影的情况；切取各站淋巴结行病理检查。结果 288例胃癌术后病理诊断为T1期102例，T2期126例，T3期60例。术中成功显影270例，阳性率为93．8％。102例患者有淋巴结转移，其中前哨淋巴结（SNs）与非前哨淋巴结（non—SNs）均有转移者66例，仅前哨淋巴结有转移者18例，仅非前哨淋巴结有转移者18例。结论 通过前哨淋巴结，术中能准确预测胃癌淋巴结转移状况。在手术治疗淋巴结转移阴性的胃癌患者中，前哨淋巴结术中标识有望免除常规淋巴清扫。     

Sentinel Node Mapping and Skip Metastases in Patients with Early Gastric Cancer

Objectives  This study was designed to identify the characteristics of patients with early gastric cancers that have skip metastases. Background   The possibility of lymph node metastasis is the most important factor to consider when deciding on the resection procedure for patients with early gastric cancer. Methods  From February 2003 through July 2008, 739 patients with early gastric adenocarcinoma underwent gastric resection at the National Cancer Center, Korea, and were included in this study. Patients with skip metastases were analyzed and compared with those without skip metastases. Results  Skip metastases were found in 2.8% of patients with early gastric cancer. Tumor size and the presence of lymphatic invasion were associated with skip metastases by both univariate and multivariate analysis. All skip metastases were metastases to the extraperigastric lymph nodes that skipped across the perigastric lymph nodes. Sixteen patients (66.7%) with these metastases had metastatic lymph nodes at No. 7, 8, and 9 stations. Conclusions  Tumor size should be considered during sentinel lymph node mapping to prevent false-negative results in patients with early gastric cancer. If sentinel nodes are not found in the perigastric lymph nodes, No. 7, 8, and 9 stations should be explored for prevention of false-negative sentinel node mapping results.     

Skip metastases in thyroid cancer leaping the central lymph node compartment

HYPOTHESIS: Discontinuous nodal metastasis, or skip metastasis, in thyroid cancer may display clinicopathologic features different from those seen in continuous nodal metastasis and thus may have a different prognosis. DESIGN: Retrospective analysis. SETTING: Tertiary referral center at a university hospital. PATIENTS: Two hundred fifteen consecutive patients who underwent systematic central lymph node dissection for papillary, follicular, or medullary thyroid cancer and who on histopathologic analysis exhibited nodal metastases in at least 1 lateral or mediastinal lymph node compartment. MAIN OUTCOME MEASURES: Various clinicopathologic variables that were stratified for tumor entity and type of nodal metastasis (discontinuous vs continuous). RESULTS: Skip metastases (negative central and positive lateral or mediastinal compartments) were found in 13 (19.7%) of 66 papillary, 0 of 8 follicular, and 30 (21.3%) of 141 medullary thyroid cancers. After adjustment for multiple testing, skip metastasis was only associated with significantly fewer positive lymph nodes: 3.7 vs 12.9 nodes (r = -0.43, P<.001) in papillary thyroid cancer and 6.0 vs 17.1 nodes (r = -0.40, P<.001) in medullary thyroid cancer. No other significant correlation was identified with any other clinicopathologic variable. CONCLUSIONS: Skip metastasis is an epiphenomenon of low-intensity nodal metastasis in thyroid cancer and entails a moderate risk of local recurrence. Consequently, clearing the central lymph node compartment should be considered when lateral or mediastinal lymph node compartments are involved.     

胃癌前哨淋巴结研究进展

前哨淋巴结是从原发肿瘤淋巴引流途中首先可能发生转移的部位。Cabana在阴茎癌中提出前哨淋巴结的概念后,前哨淋巴结活检技术不断在多种肿瘤中广泛应用。目前,该技术已成功用于黑色素瘤、乳腺癌等手术。但在胃癌中,由于胃淋巴引流复杂、存在跳跃转移以及假阴性率较高,前哨淋巴结活检技术应用于临床还为时过早,其可行性和适用性尚无定论。因此,前哨淋巴结活检技术应用于胃癌,还有许多问题需要回答。     

Area of nodal metastasis and radioisotope uptake in sentinel nodes of upper gastrointestinal cancer

BACKGROUND: Sentinel node navigation surgery has been introduced for the treatment of gastrointestinal tumor. As few studies have examined relationships between metastatic area and radioisotope uptake in sentinel nodes, the present study examined this relationship for gastric and esophageal cancers. METHODS: Subjects comprised 43 patients (esophageal cancer, n = 19; gastric cancer, n = 24) with < or =3 lymph node metastases in whom sentinel node mapping with radio-guided methods was performed. Radioisotope uptake was measured after surgery for all dissected lymph nodes. Metastatic area was calculated using the following formula: metastatic area (%) = (area of metastasis/total area of lymph node) x 100. Based on radioisotope uptake, lymph nodes were divided into RI(-) and RI(+) groups. RESULTS: In 35 patients, > or =1 metastatic node was present among the sentinel nodes. In 1 patient, no sentinel nodes were detected. No lymph node metastasis was found in sentinel nodes in the remaining seven patients. Lymph nodes were diagnosed as metastatic using preoperative imaging. Mean (+/-SD) metastatic area was significantly higher for RI(-) (68.3 +/- 20.5%) than for RI(+) (15.1 +/- 20.8%; P < 0.0001). Radioisotope uptake was decreased in lymph nodes with >60% metastatic area. CONCLUSIONS: The fact that radioisotope uptake is not detectable in some lymph nodes with >60% metastatic area must be considered when planning sentinel node navigation surgery.