Abstract
Gastric carcinoma (GC) locoregional recurrence may occur even in cases where the tumor has been completely resected, possibly due to lymph node (LN) micrometastases. It is estimated that in 10% to 30% of cases, LN micrometastases are not detected by a conventional method for histological assessment of LN metastases with hematoxylin-eosin (HE). A cross-sectional study assessed 51 patients with GC by histological evaluation of the LN micrometastases through LN multi sectioning associated with immunohistochemistry analysis with monoclonal antibodies AE1 and AE3. Total gastrectomy was performed in 51% of patients. The total number of resected LN nodes was 1698, with a mean number of resected LN of 33.3 ± 13.2 per surgical specimen, of which 187 had metastasis. After the application of LN multisection and immunohistochemistry, LN micrometastases were found in 45.1% of the cases. LN staging changed in 29.4%, and tumor staging changed in 23.5% of the cases. In patients initially staged as pN0, LN staging and tumor staging changed, both in 19.2% of the cases. In patients initially staged as pN1 or more, LN staging changed in 40.0% of them, and tumor staging changed in 28.0% of the cases. The accuracy of HE for the histological staging of LN tumoral involvement was 76%, which was considered insufficient for CG patients staging. Investigation of LN micrometastasis through LN multisection and immunohistochemistry should be performed, particularly in cases where the presence of blood and lymphatic vessel invasion has been identified after conventional histological analysis, as well as in patients with advanced GC.
Highlights
Gastric carcinoma (GC), despite the recent decrease observed in its incidence, remains the second most common cause of cancer death in the world, with more than 600,000 deaths per year
Recent literature has discussed the role of lymph node (LN) micrometastasis in GC
The presence of micrometastasis may be related to locoregional recurrence, as one can see in wholly resected GC initially staged without LN metastasis at traditional histological analysis using hematoxylin-eosin (HE)
Summary
Gastric carcinoma (GC), despite the recent decrease observed in its incidence, remains the second most common cause of cancer death in the world, with more than 600,000 deaths per year. The standard procedure for the treatment of this condition is radical gastrectomy, which includes gastric resection with surgical margins free of neoplasia, associated with extended locoregional lymphadenectomy[1,2,3]. The routine evaluation of LN resected during radical gastrectomy, which includes analysis of only one LN histological section with HE, can result in the non-identification of micrometastases. This may generate a suboptimal LN staging and, lead to therapeutic measures that may be insufficient for the accuracy of the tumor staging[10,11]
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