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

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Abstract

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.

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References

  1. Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M (2006) Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg 203:162–169

    Article  PubMed  Google Scholar 

  2. Hyung WJ, Cheong JH, Kim J, Chen J, Choi SH, Noh SH (2004) Application of minimally invasive treatment for early gastric cancer. J Surg Oncol 85:181–185

    Article  PubMed  Google Scholar 

  3. Kitano S, Shiraishi N (2005) Minimally invasive surgery for gastric tumors. Surg Clin N Am 85:151–164

    Article  PubMed  Google Scholar 

  4. Kim MC, Kim HH, Jung GJ, Lee JH, Choi SR, Kang DY, Roh MS, Jeong JS (2004) Lymphatic mapping and sentinel node biopsy using 99 mTc tin colloid in gastric cancer. Ann Surg 239:383–387

    Article  PubMed  Google Scholar 

  5. Kitagawa Y, Fujii H, Kumai K, Kubota T, Otani Y, Saikawa Y, Yoshida M, Kubo A, Kitajima M (2005) Recent advances in sentinel node navigation for gastric cancer: a paradigm shift of surgical management. J Surg Oncol 90:147–151

    Article  PubMed  Google Scholar 

  6. Amersi F, Morton DL (2007) The role of sentinel lymph node biopsy in the management of melanoma. Adv Surg 41:241–256

    Article  PubMed  Google Scholar 

  7. Lyman GH, Giuliano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ, Cochran AJ, Cody HS III, Edge SB, Galper S, Hayman JA, Kim TY, Perkins CL, Podoloff DA, Sivasubramaniam VH, Turner RR, Wahl R, Weaver DL, Wolff AC, Winer EP, American Society of Clinical Oncology (2005) American society of clinical oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703–7720

    Article  PubMed  Google Scholar 

  8. Abe N, Mori T, Takeuchi H, Yoshida T, Ohki A, Ueki H, Yanagida O, Masaki T, Sugiyama M, Atomi Y (2005) Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer. Am J Surg 190:496–503

    Article  PubMed  Google Scholar 

  9. Ichikura T, Chochi K, Sugasawa H, Yaguchi Y, Sakamoto N, Takahata R, Kosuda S, Mochizuki H (2006) Individualized surgery for early gastric cancer guided by sentinel node biopsy. Surgery 139:501–507

    Article  PubMed  Google Scholar 

  10. Ichikura T, Sugasawa H, Sakamoto N, Yaguchi Y, Tsujimoto H, Ono S (2009) Limited gastrectomy with dissection of sentinel node stations for early gastric cancer with negative sentinel node biopsy. Ann Surg 249:942–947

    Article  PubMed  Google Scholar 

  11. Otani Y, Furukawa T, Kitagawa Y, Yoshida M, Saikawa Y, Kubota T, Kumai K, Matsui H, Kitajima M (2004) New method of laparoscopy-assisted function-preserving surgery for early gastric cancer: vagus-sparing segmental gastrectomy under sentinel node navigation. J Am Coll Surg 198:1026–1031

    Article  PubMed  Google Scholar 

  12. Gretschel S, Schlag PM (2010) Current status of sentinel lymph node biopsy in adenocarcinoma of the distal esophagus, gastric cardia, and proximal stomach. Recent Results Cancer Res 182:107–114

    Article  PubMed  Google Scholar 

  13. Kitagawa Y, Saha S (2007) Current status and future clinical applications of lymphatic mapping in gastrointestinal cancer. J Gastroenterol 42:927–931

    Article  PubMed  Google Scholar 

  14. Hayashi H, Tangoku A, Suga K, Shimizu K, Ueda K, Yoshino S, Abe T, Sato T, Matsunaga N, Oka M (2006) CT lymphography-navigated sentinel lymph node biopsy in patients with superficial esophageal cancer. Surgery 139:224–235

    Article  PubMed  Google Scholar 

  15. Hyung WJ, Kim YS, Lim JS, Kim MJ, Noh SH, Kim KW (2010) Preoperative imaging of sentinel lymph nodes in gastric cancer using CT lymphography. Yonsei Med J 51:407–413

    Article  PubMed  Google Scholar 

  16. Suga K, Shimizu K, Kawakami Y, Tangoku A, Zaki M, Matsunaga N, Oka M (2005) Lymphatic drainage from esophagogastric tract: feasibility of endoscopic CT lymphography for direct visualization of pathways. Radiology 237:952–960

    Article  PubMed  Google Scholar 

  17. Tsujimoto H, Yaguchi Y, Sakamoto N, Kumano I, Takahata R, Matsumoto Y, Yoshida K, Sugasawa H, Ono S, Ichikura T, Yamamoto J, Hase K (2010) Computed tomography lymphography for the detection of sentinel nodes in patients with gastric carcinoma. Cancer Sci 101:2586–2590

    Article  PubMed  CAS  Google Scholar 

  18. Chung YE, Hyung WJ, Kweon S, Lim SJ, Choi J, Lee MH, Kim H, Myoung S, Lim JS (2010) Feasibility of interstitial CT lymphography using optimized iodized oil emulsion in rats. Invest Radiol 45:142–148

    Article  PubMed  Google Scholar 

  19. Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer 1:10–24

    Article  PubMed  Google Scholar 

  20. Gotoda T, Iwasaki M, Kusano C, Seewald S, Oda I (2010) Endoscopic resection of early gastric cancer treated by guideline and expanded national cancer centre criteria. Br J Surg 97:868–871

    Article  PubMed  CAS  Google Scholar 

  21. Goto O, Fujishiro M, Kodashima S, Ono S, Omata M (2009) Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 41:118–122

    Article  PubMed  CAS  Google Scholar 

  22. Song KY, Hyung WJ, Kim HH, Han SU, Cho GS, Ryu SW, Lee HJ, Kim MC, Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group (2008) Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? A large-scale Korean multi-center study. J Surg Oncol 98:6–10

    Article  PubMed  Google Scholar 

  23. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H (1999) Can sentinel node biopsy indicate rational extent of lymphadenectomy in gastric cancer surgery? Fundamental and new information on lymph-node dissection. Langenbecks Arch Surg 384:149–157

    Article  PubMed  CAS  Google Scholar 

  24. Lee JH, Ryu KW, Kook MC, Lee JY, Kim CG, Choi IJ, Kim SK, Jang S, Park SR, Kim YW, Nam BH, Bae JM (2008) Feasibility of laparoscopic sentinel basin dissection for limited resection in early gastric cancer. J Surg Oncol 98:331–335

    Article  PubMed  Google Scholar 

  25. Park DJ, Kim HH, Park YS, Lee HS, Lee WW, Lee HJ, Yang HK (2011) Simultaneous indocyanine green and (99 m)Tc-antimony sulfur colloid-guided laparoscopic sentinel basin dissection for gastric cancer. Ann Surg Oncol 18:160–165

    Article  PubMed  Google Scholar 

  26. Suga K, Ogasawara N, Yuan Y, Okada M, Matsunaga N, Tangoku A (2003) Visualization of breast lymphatic pathways with an indirect computed tomography lymphography using a nonionic monometric contrast medium iopamidol: preliminary results. Invest Radiol 38:73–84

    Article  PubMed  Google Scholar 

  27. Wilhelm AJ, Mijnhout GS, Franssen EJ (1999) Radiopharmaceuticals in sentinel lymph-node detection—an overview. Eur J Nucl Med 26:S36–S42

    PubMed  CAS  Google Scholar 

  28. Leidenius MH, Leppanen EA, Krogerus LA, Smitten KA (2004) The impact of radiopharmaceutical particle size on the visualization and identification of sentinel nodes in breast cancer. Nucl Med Commun 25:233–238

    Article  PubMed  Google Scholar 

  29. Mariani G, Erba P, Villa G, Gipponi M, Manca G, Boni G, Buffoni F, Castagnola F, Paganelli G, Strauss HW (2004) Lymphoscintigraphic and intraoperative detection of the sentinel lymph node in breast cancer patients: the nuclear medicine perspective. J Surg Oncol 85:112–122

    Article  PubMed  Google Scholar 

  30. Bembenek A, Gretschel S, Schlag PM (2007) Sentinel lymph node biopsy for gastrointestinal cancers. J Surg Oncol 96:342–352

    Article  PubMed  CAS  Google Scholar 

  31. Lee YJ, Ha WS, Park ST, Choi SK, Hong SC, Park JW (2008) Which biopsy method is more suitable between a basin dissection and pick-up biopsy for sentinel nodes in laparoscopic sentinel-node navigation surgery (LSNNS) for gastric cancer? J Laparoendosc Adv Surg Tech A 18:357–363

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a Korea Science and Engineering Foundation (KOSEF) grant funded by the Korean government (MOST) (No. R01-2007-000-20501-0) and the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2010-0021549).

Disclosures

Drs. Joon Seok Lim, Junjeong Choi, Jyewon Song, Yong Eun Chung, Soo-Jeong Lim, Sang Kil Lee, and Woo Jin Hyung have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Radiology, Yonsei University College of Medicine, Seoul, Korea

    Joon Seok Lim & Yong Eun Chung

  2. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

    Junjeong Choi

  3. Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Jyewon Song & Woo Jin Hyung

  4. Department of Bioscience and Bioengineering, Sejong University, Seoul, Korea

    Soo-Jeong Lim

  5. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

    Sang Kil Lee

  6. Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea

    Woo Jin Hyung

  7. Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea

    Woo Jin Hyung

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  1. Joon Seok Lim
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Correspondence to Woo Jin Hyung.

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Lim, J.S., Choi, J., Song, J. et al. Nanoscale iodized oil emulsion: a useful tracer for pretreatment sentinel node detection using CT lymphography in a normal canine gastric model. Surg Endosc 26, 2267–2274 (2012). https://doi.org/10.1007/s00464-012-2170-2

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