Abstract
BackgroundIn sentinel node (SN) detection for cases of early gastric cancer, the submucosal dye injection method appears to be more reasonable than the subserosal injection. To compare the two injection methods, we have focused on the rate of concordance between hot nodes (HNs) obtained from the radioisotope (RI) method and green nodes (GNs) obtained from the dye-guided method in addition to the number and distribution of GNs detected, and the sensitivity of metastatic detection.MethodsThe subjects of this study were 63 consecutive patients with gastric cancer (sT1–T2, sN0, tumor diameter ≦ 4 cm) in whom we attempted SN detection using a combination of RI and dye methods. 99mTc-tin colloid was injected a day before the surgery, and indocyanine green was injected either submucosally (n = 43) with endoscopes or subserosally (n = 20) by direct vision.ResultsAn average of hot and green nodes (H&G: 4 ± 3 vs. 4 ± 3), hot and non-green nodes (H&NG: 2 ± 3 vs. 1 ± 2), cold and green nodes (C&G: 2 ± 2 vs. 3 ± 4), and the rate of concordance (H&G/H&G + H&NG + C&G: 45 + 27% vs. 48 ± 30%) were not significantly different between the submucosal and subserosal injection methods. The spread of GNs to tier 2 stations (24% vs. 30%) and metastatic detection sensitivity (86% vs. 100%) were also not different between the submucosal and subserosal injection methods.ConclusionThe tracer injection sites do not have to be limited to the submucosa.
Highlights
In sentinel node (SN) detection for cases of early gastric cancer, the submucosal dye injection method appears to be more reasonable than the subserosal injection
There were no significant differences in the clinicopathological characteristics between the 43 patients who received submucosal injection of indocyanine green (ICG) solution and the 20 patients who received subserosal injection (Table 1)
No differences were observed in the numbers of hot and green nodes (H&G), hot and non-green nodes (H&NG), cold and green nodes (C&G), and GNs between the two groups of patients
Summary
In sentinel node (SN) detection for cases of early gastric cancer, the submucosal dye injection method appears to be more reasonable than the subserosal injection. To compare the two injection methods, we have focused on the rate of concordance between hot nodes (HNs) obtained from the radioisotope (RI) method and green nodes (GNs) obtained from the dye-guided method in addition to the number and distribution of GNs detected, and the sensitivity of metastatic detection. When a detection procedure is administered for cases of early gastric cancer, submucosal injection appears to be more reasonable, but there are no reliable comparative studies of submucosal injection and subserosal injection for this purpose. We compared the two methods of injection, submucosal or subserosal, focusing on the rate of concordance between hot nodes (HNs) obtained from the RI method and green nodes (GNs) obtained from the dye-guided method. We have weighed the merits of each injection method
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