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Assessment of Sentinel Node Concept in Esophageal Cancer Based on Lymph Node Micrometastasis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The clinical significance of lymph node micrometastasis remains unclear in patients with esophageal cancer. Therefore, accurate assessment of lymph node status including micrometastasis is important when performing sentinel node (SN) navigation surgery. The purpose of the present study was to investigate the adequacy of SN concept based on lymph node micrometastasis determined by immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) in patients with esophageal cancer.

Methods

A total of 57 patients with esophageal cancer who were preoperatively diagnosed as having T1–T2 (cT1–T2) and N0 (cN0) were enrolled. They underwent standard esophagectomy with lymph node dissection. One day before surgery, a total of 3 mCi of 99mTechnetium-tin colloid was endoscopically injected into the submucosa around the tumor. During the operation, radioisotope uptake in the lymph nodes was measured using Navigator GPS. All dissected lymph nodes were investigated by RT-PCR using the double marker of CEA and SCC, hematoxylin-eosin (HE) staining, and IHC.

Results

Node-positive incidence identified by HE and IHC was 12.3 % (7/57) and 19.3 % (11/57), respectively. RT-PCR demonstrated micrometastasis in four of 46 patients without nodal metastasis determined by HE staining and IHC. No non-SN metastases were found in 42 patients without micrometastasis identified by IHC and RT-PCR of SN. Accuracy and false negative rates were 100 % (57/57) and 0 % (0/42), respectively.

Conclusions

SN concept might be acceptable in patients with cT1–T2 and cN0 esophageal cancer, even in the presence of micrometastasis identified by IHC and RT-PCR.

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CONFLICT OF INTEREST

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Digestive Surgery, Breast and Thyroid Surgery, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Takahiko Hagihara MD, Takaaki Arigami MD, Tsutomu Kozono MD, Hideo Arima MD, Shigehiro Yanagita MD, Munetsugu Hirata MD, Katsuhiko Ehi MD, Hiroshi Okumura MD, Masataka Matsumoto MD, Yasuto Uchikado MD, Sumiya Ishigami MD & Shoji Natsugoe MD

  2. Molecular Frontier Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Yoshikazu Uenosono MD, Takaaki Arigami MD & Shoji Natsugoe MD

Authors
  1. Takahiko Hagihara MD
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  2. Yoshikazu Uenosono MD
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  3. Takaaki Arigami MD
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  4. Tsutomu Kozono MD
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Correspondence to Takahiko Hagihara MD.

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Hagihara, T., Uenosono, Y., Arigami, T. et al. Assessment of Sentinel Node Concept in Esophageal Cancer Based on Lymph Node Micrometastasis. Ann Surg Oncol 20, 3031–3037 (2013). https://doi.org/10.1245/s10434-013-2973-y

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  • DOI: https://doi.org/10.1245/s10434-013-2973-y

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