Lymphatic mapping for gastric adenocarcinoma.

Jon C. Hundley, Perry Shen, Stephen A Shiver, Kim R. Geisinger, Edward A. Levine

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

The role of lymphadenectomy for gastric carcinoma has been debated for decades. Lymphatic mapping has revolutionized the treatment of melanoma and breast cancer. However, its potential utility in guiding lymphadenectomy for gastric carcinoma is unknown. Therefore we initiated a trial to investigate lymphatic mapping for gastric carcinoma at Wake Forest University Baptist Medical Center. Lymphatic mapping for gastric carcinoma was attempted in 14 cases of gastric carcinoma. Mapping was performed by perilesional injection of isosulfan blue and the first node in the draining basin was harvested and sent fresh to pathology. Sentinel lymph nodes (SLNs) were evaluated by hematoxylin and eosin (H&E) staining. Immunohistochemical analysis was performed on all SLNs that were found to be negative on initial histologic studies. Radical gastrectomy with celiac node dissection was performed in all cases. SLNs were identified in 14 cases. In one case the technique was abandoned because of bulk nodal disease. The average number of SLNs found in each case was 2.8 with a range of one to five. Eight of 14 patients were found to have SLNs positive for metastatic carcinoma. In seven of these patients pathologic analysis of the final resection specimen confirmed the presence of nodal disease. In one case carcinoma was found in a SLN on touch preparation and no nodal disease was noted in the resection specimen. Immunohistochemical studies performed on SLNs found to be negative on initial H&E histologic analysis failed to reveal the presence of carcinoma. The overall sensitivity and specificity were found to be 72.7 and 75 per cent, respectively. Lymphatic mapping is technically possible in the setting of gastric carcinoma and SLNs can be successfully identified in the majority of cases. Upstaging occurred in one case which may have ramifications for adjuvant therapy. SLN positivity accurately predicts the presence of additional nodal disease beyond the SLN in the final resection specimen (positive predictive value 89%). However, SLN negativity does not definitively prove that the remaining nodal basin is free of disease (negative predictive value 50%). Lymphatic mapping for gastric carcinoma is a promising technique worthy of further investigation.

Original languageEnglish (US)
Pages (from-to)931-935
Number of pages5
JournalThe American surgeon
Volume68
Issue number11
StatePublished - Jan 1 2002
Externally publishedYes

Fingerprint

Stomach
Adenocarcinoma
Carcinoma
Lymph Node Excision
Sentinel Lymph Node
Touch
Hematoxylin
Gastrectomy
Eosine Yellowish-(YS)
Abdomen
Dissection
Melanoma
Pathology
Staining and Labeling
Breast Neoplasms
Sensitivity and Specificity
Injections
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Hundley, J. C., Shen, P., Shiver, S. A., Geisinger, K. R., & Levine, E. A. (2002). Lymphatic mapping for gastric adenocarcinoma. The American surgeon, 68(11), 931-935.

Lymphatic mapping for gastric adenocarcinoma. / Hundley, Jon C.; Shen, Perry; Shiver, Stephen A; Geisinger, Kim R.; Levine, Edward A.

In: The American surgeon, Vol. 68, No. 11, 01.01.2002, p. 931-935.

Research output: Contribution to journalArticle

Hundley, JC, Shen, P, Shiver, SA, Geisinger, KR & Levine, EA 2002, 'Lymphatic mapping for gastric adenocarcinoma.', The American surgeon, vol. 68, no. 11, pp. 931-935.
Hundley JC, Shen P, Shiver SA, Geisinger KR, Levine EA. Lymphatic mapping for gastric adenocarcinoma. The American surgeon. 2002 Jan 1;68(11):931-935.
Hundley, Jon C. ; Shen, Perry ; Shiver, Stephen A ; Geisinger, Kim R. ; Levine, Edward A. / Lymphatic mapping for gastric adenocarcinoma. In: The American surgeon. 2002 ; Vol. 68, No. 11. pp. 931-935.
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