Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction

Objective: To determine the adequacy of sentinel node (SN) concept based on micrometastasis using immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) in gastric cancer. Summary Background Data: The SN concept has recently been introduced in gastrointestinal tract cancers. The precise detection of lymph node metastasis including micrometastasis is important for SN navigation surgery. Methods: Sixty-one patients with gastric cancer who were preoperatively diagnosed with T1-T2 (cT1-T2) and NO (cNO) were enrolled. They underwent standard radical gastrectomy with lymph node dissection. One day before surgery, 4 mCi of (99m)Technetiurntin colloid was endoscopically injected into the submucosa around the tumor. During surgery, radioisotope uptake in the lymph node was measured using Navigator GPS. All dissected lymph nodes were examined by RT-PCR in addition to hematoxylin and eosin staining and IHC. Results: Sentinel nodes were identified in all patients (100%). The incidences of metastasis determined by liernatoxylin and eosin and IHC were 8.2% (5 of 61) and 13.1% (8 of 61), respectively. Micrometastases undetectable by IHC were identified in 14 patients (23.0%) by RT-PCR. Only 1 patient had inicrometastasis detectable by RT-PCR in lymph nodes other than SN, but this patient had a cT2 tumor. In patients with cT1 and cN0 tumors, the false negative and accuracy rates were 0% and 100%, respectively. Conclusions: Although the incidence of micrometastasis detected by RT-PCR was quite high, SN navigation identified such trietastasis in all patients except one. Thus, the SN concept was applicable to patients with cTI and cNO gastric cancer, even when inicrornetastasis was detectable by RT-PCR.