Article
Combination of ex vivo sentinel lymph node mapping and methylene blue assisted lymph node dissection in gastric cancer: a prospective and randomized study
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Authors
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Johann Bernhard Spatz
- Zentralklinikum Augsburg, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Augsburg
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Hans M. Arnholdt
- Zentralklinikum Augsburg, Institut für Pathologie, Augsburg
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Matthias Anthuber
- Klinikum Augsburg, Allgemein-, Viszeral-, Transplantationschirurgie, Augsburg
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Bruno Märkl
- Zentralklinikum Augsburg, Institut für Pathologie, Augsburg
| Published: | May 20, 2011 |
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Outline
Text
Introduction: Exact lymph node staging is crucial to estimate prognosis of gastric cancer and stratify treatment. Recently, a new concept for improving lymph node harvest and the accuracy of lymph node staging was introduced. It combines methylene blue assisted lymph node dissection (MBLND) with a new ex vivo sentinel lymph node (evSLN) mapping technique. Aim of this study was to investigate these techniques in a prospective and randomized manner.
Materials and methods: 50 patients with proved or suspected gastric cancer were enrolled. Patients were randomized to either conventional technique (Unstained, n=25) or MBLND (Methylene, n=25). In 46 cases additional evSLN mapping was performed using black ink as marker dye.
Results: MBLND significantly improved lymph node harvest (36 ± 10 vs. 21 ± 10; P < 0.001) in comparison to conventional technique. The biggest differences were seen in LNs ≤ 6 mm. Sufficient lymph node harvest was achieved in 96% of the Methylene group compared to 56% of the Unstained group (P = 0.002). In contrast to conventional technique adequate lymph node harvest was archieved irrespective of partial gastrectomy or preoperative chemotherapy in the Methylene group. The SLN detection rate, sensitivity and accuracy were 87%, 81% and 93%, respectively. The probability to show metastatic involvement was twice as high in the SLN than in the rest of the lymph nodes. Isolated tumor cells were detected after immunohistochemical staining in 3 of 17 cases 18%.
Conclusion: MBLND significantly improves lymph node harvest in gastric cancer . Moreover, evSLN mapping is feasible and holds the potential to increase detection of metastatic nodules.
