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Sentinel Lymph Node Biopsy in Esophageal Cancer: Should It Be Standard of Care?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Sentinel node mapping is established in some superficial cancers but remains controversial in harder-to-access solid tumors. There are an increasing number of recent studies suggesting that isolated tumor cells have prognostic significance in predicting poor survival, in breast cancer, esophageal cancer, and others. It is for this reason that we have persevered with the sentinel lymph node concept in our esophagectomy cancer patients, and we report our results since 2008.

Methods

Thirty-one of 32 consecutive patients underwent resection for invasive esophageal cancer along with sentinel lymph node retrieval (resection rate, 97%). Peritumoral injection of 99mTc antimony colloid was performed by upper endoscopy prior to the operation. A two-surgeon synchronous approach via a right thoracotomy and laparotomy was performed with a conservative lymphadenectomy. Sentinel lymph nodes were identified with a gamma probe both in and ex vivo, and sent off separately for three serial sections and immunohistochemistry with AE1/AE3.

Results

The median patient age was 63.4 years (range, 45–75 years). Most patients (81%) had an adenocarcinoma, and 61% had received neoadjuvant therapy. At least one sentinel lymph node (median, 3) was identified in 29 of 31 patients (success rate, 94%). Sentinel nodes were present in more than one nodal station in 16 patients (55%). One false negative case led to a sensitivity of 90%. In 28 of 29 patients, the sentinel lymph node accurately predicted findings in non-sentinel nodes (accuracy, 96%).

Conclusions

Sentinel lymph node biopsy is both feasible and accurate in esophageal resections with conservative lymphadenectomy. It allows targeted serial sectioning and immunohistochemical studies of those nodes and should become standard of care in patients undergoing esophagectomy for esophageal cancer.

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Acknowledgments

This work was funded by a 2008 Research Grant from the Society of American Gastroenterologists and Surgeons (SAGES). We would like to thank Andrew Ruszkiewicz (specialist gastrointestinal pathologist) for performing a detailed analysis of the sentinel lymph nodes in this study, and Peter Devitt, Philip Game, and Andrew Lord (upper gastrointestinal surgeons) for their cooperation with this study.

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Authors and Affiliations

  1. Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia

    Sarah K. Thompson & Glyn G. Jamieson

  2. Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Dylan Bartholomeusz

  3. Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Dylan Bartholomeusz

  4. Department of Surgery, Royal Adelaide Hospital, Level 5, Eleanor Harrald Building, Adelaide, South Australia, 5000, Australia

    Sarah K. Thompson

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  1. Sarah K. Thompson
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  2. Dylan Bartholomeusz
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  3. Glyn G. Jamieson
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Correspondence to Sarah K. Thompson.

Additional information

Supported by a 2008 Research Grant from the Society of American Gastroenterologists and Surgeons (SAGES)

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Thompson, S.K., Bartholomeusz, D. & Jamieson, G.G. Sentinel Lymph Node Biopsy in Esophageal Cancer: Should It Be Standard of Care?. J Gastrointest Surg 15, 1762–1768 (2011). https://doi.org/10.1007/s11605-011-1634-3

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