Sentinel node mapping in esophageal squamous cell carcinoma using intra-operative combined blue dye and radiotracer techniques

Background

Extended surgeries such as two- or three-field lymph node dissections are gaining more acceptance for treatment of esophageal cancer. Sentinel node biopsy is an alternative approach in this regard. In the current study we evaluated the accuracy of sentinel node mapping of the squamous cell carcinoma of the esophagus using intra-operative combined blue dye and radiotracer techniques.

Methods

Immediately after thoracotomy and before mobilizing the tumor, 1 mCi/0.4 ml Tc-99 m-antimony sulfide colloid was injected in two sites proximal and distal to the tumor. Concomitantly, 2 ml of 1 % methylene blue was also injected in the same manner. Sentinel nodes were removed and sent for frozen section and H&E staining. A two-field lymphadenectomy was performed for all patients.

Results

Twenty-three patients were included in the study. The detection rate was 100 %. Eleven patients had pathological lymph node involvement and in 10 patients sentinel node was pathologically positive too. Frozen section results showed 100 % concordant with H&E results. One patient with a false negative result had a pT3 tumor.

Conclusions

Sentinel node mapping in SCC of the mid to distal esophagus is feasible and accurate, especially in pT1 and pT2 tumors.