Value of the Sentinel Node Biopsy in Gastric Cancer

Sentinel Node Biopsy

DR. Sergio Ralon

Abstract.


The aim of this study was to evaluate the predictive value of sentinel node biopsy for invasive Gastric Cancer. Between January 1998 and June 2001 we had 45 patients with gastric cancer underwent exploratory laparatomy, from these 45 a total of 15 patients with invasive operable Gastric Cancer in surgical stages T2N0M0/ T3N0M0 underwent patent blue dye lymphatic mapping and sentinel node biopsy followed by D2 lymphatic dissection. The sentinel node was identified in 12/15.The false –negative rate was 16%, the sentinel node was predictive of the lymphatic status in 85%, the sensitivity was 85%, and the specificity 100%. Sentinel node biopsy in Gastric Cancer seems a good alternative to enhancing the selectivity of Lymph node dissection and avoid the morbidity of the major lymphadenectomy in Gastric Cancer.


The concept of lymphatic mapping in gastric malignancies is not new, was first reported by Weinberg and Greaney in 1950 with the specific goal of looking the primary nodes (1); however the most important contribution in clinical use was reported by Cabanas in 1977 in patients with penile cancer; Cabanas articulated the principles and present understanding of the Sentinel lymph node concept. He proved that the pathologic status of the sentinel lymph node provided a rational basis for selective lymphadenectomy (2). In 1992 the intraoperative lymphatic mapping and sentinel node biopsy was described by Morton in patients with Melanoma (3) and in 1994, Giuliano established the technique in patients with breast Cancer (4).

With the same concept, that pathologic status of the sentinel node can be predictive of the status of the rest of lymph nodes, we performed this study with the goal of use the sentinel node in Gastric Cancer and have an better parameter in the selection of which patients need extensive lymphadenectomy.