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Sentinel nodes of malignancies originating in the alimentary tract

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An Erratum to this article was published on 01 May 2004

Abstract

The feasibility of the sentinel node concept for malignancies originating in the alimentary tract is attracting much interest among researchers in the field of gastrointestinal oncology. We have tested more than 350 such cases and obtained favorable and promising initial results. The detectability of sentinel nodes using endoscopically injected Tc-99m tin colloid for these tumors exceeded 90%. Although the false negative ratio was not so low (~10%), most of these cases had an inaccurate preoperative evaluation of mural invasion and/or a technically unfavorable injection. When the indication is restricted to patients with early-stage disease, and when the radioactive colloid is properly administered, sentinel node navigation therapy would be applicable for gastrointestinal malignancies.

To achieve successful sentinel node navigation surgery it is essential to accurately identify sentinel nodes, and lymphoscintigraphy is a very useful test to confirm the location of sentinel nodes preoperatively. However, image processing is required for lymphoscintigrams because the original image depicts only high activity at the injection site and faint radioactivity in the sentinel nodes. We have clearly imaged the silhouette of the body using Compton scattered photons, and have also proposed several methods to improve the contrast between the injection sites and sentinel nodes. Many sentinel nodes can be clearly visualized by subtraction of the background activity with heterogeneous distribution.

The development of the portable gamma camera, enabling intraoperative imaging, also contributes to less invasive biopsy of sentinel nodes. We have obtained promising initial results using a portable imaging device with semiconductor detectors.

These promising results suggest that sentinel node navigation therapy including radiotherapy will be a new therapy for early-stage gastrointestinal malignancies in the near future, with nuclear medicine contributing to the establishment of new, less invasive therapies for gastrointestinal cancer.

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References

  1. Kitagawa Y, Kitajima M. Gastrointestinal cancer and sentinel node navigation surgery.J Surg Oncol 2002; 79: 188–193.

    Article  PubMed  Google Scholar 

  2. Kurihara N, Kubota T, Otani Y, Ohgami M, Kumai K, Sugiura H, et al. Lymph node metastasis of early gastric cancer with submucosal invasion.Br J Surg 1998; 85: 835–839.

    Article  PubMed  CAS  Google Scholar 

  3. Duenne AA, Werner JA. Functional anatomy of lymphatic vessels under the aspect of tumor invasion.Recent Results Cancer Res 2000; 157: 82–89.

    PubMed  CAS  Google Scholar 

  4. Gould EA, Winship T, Philbin PH, Kerr HH. Observation on a “sentinel node” in cancer of the parotid.Cancer 1960; 13:77–78.

    Article  PubMed  CAS  Google Scholar 

  5. Cabanas RM. An approach for the treatment of penile carcinoma.Cancer 1977; 39: 456–466.

    Article  PubMed  CAS  Google Scholar 

  6. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma.Arch Surg 1992; 127: 392–399.

    PubMed  CAS  Google Scholar 

  7. Krag DN, Meijer SJ, Weaver DL, Loggie BW, Harlow SP, Tanabe KK, et al. Minimal-access surgery for staging of malignant melanoma.Arch Surg 1995; 130: 654–658.

    PubMed  CAS  Google Scholar 

  8. Giuliano AE. Current status of sentinel lymphadenectomy in breast cancer.Ann Surg Oncol 2001; 8 (9 Suppl): 52S-55S.

    PubMed  CAS  Google Scholar 

  9. Hisamichi S. Screening for gastric cancer.World J Surg 1989; 13:31–37.

    Article  PubMed  CAS  Google Scholar 

  10. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer.Ann Surgery 1994; 220: 391–398.

    Article  CAS  Google Scholar 

  11. Uren RF, Howman-Giles R, Thompson JF. Patterns of lymphatic drainage from the skin in patients with melanoma.J Nucl Med 2003; 44: 570–582.

    PubMed  Google Scholar 

  12. Donegan WL. Surgical clinical trials.Cancer 1984; 53 (3 Suppl): 691–699.

    Article  PubMed  CAS  Google Scholar 

  13. Yasuda K, Adachi Y, Shiraishi N, Inomata M, Takeuchi H, Kitano S. Prognostic effect of lymph node micrometastasis in patients with histologically node-negative gastric cancer.Ann Surg Oncol 2002; 9: 771–774.

    Article  PubMed  Google Scholar 

  14. Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N, Ozawa S, et al. Intraoperative lymphatic mapping and sentinel lymph node sampling in esophageal and gastric cancer.Surg Oncol Clin N Am 2002; 11: 293–304.

    Article  PubMed  Google Scholar 

  15. Hiratsuka M, Miyashiro I, Ishikawa O, Furukawa H, Motomura K, Ohigashi H, et al. Application of sentinel node biopsy to gastric cancer surgery.Surgery 2001; 129: 335–340.

    Article  PubMed  CAS  Google Scholar 

  16. Yokoyama K, Michigishi T, Kinuya S, Konishi S, Nakajima K, Tonami N. Detection of sentinel nodes with radiophar-maceuticals. (in Japanese)Gastroenterol Surg 2000; 23: 1689–1696.

    Google Scholar 

  17. Nakamura K, Fujii H, Kitagawa Y, Ikeda T, Kitajima M, Kubo A. Preparation of99mTc-colloid with particle size as you like for sentinel node detection (abstract).J Nucl Med 2001;42:20P.

    Google Scholar 

  18. Uenosono Y, Natsugoe S, Higashi H, Ehi K, Miyazono F, Ishigami S, et al. Evaluation of colloid size for sentinel nodes detection using radioisotope in early gastric cancer.Cancer Lett 2003; 200: 19–24.

    Article  PubMed  CAS  Google Scholar 

  19. Tavares MG, Sapienza MT, Galeb NA Jr, Belfort FA, Costa RR, Osorio CA, et al. The use of99mTc-phytate for sentinel node mapping in melanoma, breast cancer and vulvar cancer: a study of 100 cases.Eur J Nucl Med 2001; 28: 1597–1604.

    Article  PubMed  CAS  Google Scholar 

  20. Vera DR, Wallace AM, Hoh CK, Mattrey RF. A synthetic macromolecule for sentinel node detection:99mTc-DTPA-mannosyl-dextran.J Nucl Med 2001; 42: 951–959,

    PubMed  CAS  Google Scholar 

  21. Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N, Watanabe M, et al. The role of sentinel lymph node in gastrointestinal cancer.Surg Clin N Am 2000; 80: 1799–1809.

    Article  PubMed  CAS  Google Scholar 

  22. Burak WE Jr, Walker MJ, Yee LD, Kim JA, Saha S, Hinkle G, et al. Routine preoperative lymphoscintigraphy is not necessary prior to sentinel node biopsy for breast cancer.Am J Surg 1999; 177: 445–449.

    Article  PubMed  Google Scholar 

  23. Krynyckyi BR, Miner M, Ragonese JM, Firestone M, Kim CK, Machac J. Technical aspects of performing lymphoscintigraphy: optimization of methods used to obtain images.Clin Nucl Med 2000; 25: 978–985.

    Article  PubMed  CAS  Google Scholar 

  24. Clarke E, Notghi A, Harding K. Improved body-outline imaging technique for localization of sentinel lymph nodes in breast surgery.J Nucl Med 2002; 43: 1181–1183.

    PubMed  Google Scholar 

  25. Klutmann S, Bohuslavizki KH, Brenner W, Hoft S, Kroger S, Werner JA, et al. Lymphoscintigraphy in tumors of the head and neck using double tracer technique.J Nucl Med 1999;40:776–782.

    PubMed  CAS  Google Scholar 

  26. Fujii H, Yamashita H, Nakahara T, Ikeda T, Kitagawa Y, Iwasaki R, et al. Outlining the body contours with scattered photons in lymphoscintigraphy for sentinel nodes.Ann Nucl Med 2000; 14: 401–404.

    PubMed  CAS  Google Scholar 

  27. Fujii H, Kitagawa Y, Kubo A. Detection of sentinel nodes. (Japanese with English abstract)Jpn J Diagnostic Imaging 2002; 22: 684–695.

    Google Scholar 

  28. Goris ML, Daspit SG, McLaughlin P, Kris JP. Interpolative background subtraction.J Nucl Med 1976; 17: 744–747.

    PubMed  CAS  Google Scholar 

  29. Ogawa K, Fujii H, Kitagawa Y, Kubo A. Contrast enhancement for sentinel lymph node imaging. (Japanese with English abstract)KAKU IGAKU (Jpn J Nucl Med) 2001; 38: 317–323.

    CAS  Google Scholar 

  30. Yamashita H. Lymphoscintigraphy (in Japanese), InSentinel Node Navigation, Kitajima M, Kubo A (eds.), Tokyo; Kanehara, 2002: 64–74.

    Google Scholar 

  31. Yokoyama K. Imaging techniques for radio-guided sentinel node detection. (abstract) In Proceedings of SN 2002. 2002; 127.

  32. Mori I, Takayama T, Motomura N. The CdTe detector module and its imaging performance.Ann Nucl Med 2001; 15:487–494.

    Article  PubMed  CAS  Google Scholar 

  33. Yokoyama K, Tonami N, Tsugawa K, Kinami S, Miwa K. Sentinel node detection with radiocolloids. (in Japanese with English abstract)Jpn J Clin Radiol 2001; 46: 1373–1381.

    Google Scholar 

  34. Fujii H, Kitagawa Y, Ikeda T, Ogawa K, Kunieda E, Nakamura K, et al. Sentinel node imaging using an imaging probe with semiconductor detector. (Japanese with English abstract)Jpn J Clin Radiol 2002; 47: 1725–1733.

    Google Scholar 

  35. Tsuchimochi M, Sakahara H, Hayama K, Funaki M, Ohno R, Shirahata T, et al. A prototype small CdTe gamma camera for radioguided surgery and other imaging applications.Eur J Nucl Med Mol Imaging 2003; 30: 1605–1614.

    Article  PubMed  Google Scholar 

  36. Yasuda S, Shimada H, Chino O, Tanaka H, Kenmochi T, Takechi M, et al. Sentinel lymph node detection with Tc-99m tin colloids in patients with esophagogastric cancer.Jpn J Clin Oncol 2003; 33: 68–72.

    Article  PubMed  Google Scholar 

  37. Anzai I, Inoue T, Ito T, Shimizu M, Ryuo H, Takeuchi Y. Analysis of tomographical information of tracer distribution by using a CdZnTe semiconductor-based gamma counter equipped with using coded aperture. (in Japanese)RADIOISOTOPES 2002; 51: 505–508.

    Google Scholar 

  38. Ogawa K, Motomura N. Proposing a new myocardial SPECT system. Conference Record of IEEE Nuclear Science and Medical Imaging Conference, (CD-ROM), 2002.

  39. Mitomi T, Makuuchi H. Lymph node dissection for Tl esophageal cancer. (in Japanese with English abstract)Nippon Geka Gakkai Zasshi 1997; 98: 727–732.

    PubMed  CAS  Google Scholar 

  40. Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus.Ann Surg 1994; 220: 364–372.

    Article  PubMed  CAS  Google Scholar 

  41. Makuuchi H. Endoscopic mucosal resection for mucosal cancer in the esophagus.Gastrointest Endosc Clin N Am 2001; 11:445–458.

    PubMed  CAS  Google Scholar 

  42. Chu KU, Turner RR, Hansen NM, Brennan MB, Bilchik A, Giuliano AE. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection?Ann Surg 1999; 229: 536–541.

    Article  PubMed  CAS  Google Scholar 

  43. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Kikuchi H, et al. Is sentinel node navigation surgery applicable to gastric cancer? (in Japanese)Gastroenterol Surg 2000; 23: 1639–1645.

    Google Scholar 

  44. Ohgami M, Otani Y, Kumai K, KubotaT, Kim YI, Kitajima M. Curative laparoscopic surgery for early gastric cancer: five years experience.World J Surg 1999; 23: 187–193.

    Article  PubMed  CAS  Google Scholar 

  45. Kitagawa Y, Fujii H, Mukai M, Kubota T, Otani Y, Kitajima M. Radio-guided sentinel node detection for gastric cancer.Br J Surg 2002; 89: 604–608.

    Article  PubMed  CAS  Google Scholar 

  46. Kitagawa Y, Kitajima M. Lymphatic mapping for upper gastrointestinal malignancies.Semin Oncol (in press)

  47. Kitagawa Y, Fujii H, Kubo A, Kitajima M. Current status and future perspectives of sentinel node navigation for gastrointestinal cancers.Ann Surg Oncol (in press).

  48. Bilchik AJ, Saha S, Tsioulias GJ, Wood TF, Morton DL. Aberrant drainage and missed micrometastases: the value of lymphatic mapping and focused analysis of sentinel lymph nodes in gastrointestinal neoplasms.Ann Surg Oncol 2001;8 (9 Suppl):82S-85S.

    PubMed  CAS  Google Scholar 

  49. Kitagawa Y, Watanabe M, Hasegawa H, Yamamoto S, Fujii H, Yamamoto K, et al. Sentinel node mapping for colorectal cancer with radioactive tracer.Dis Colon Rectum 2002; 45: 1476–1480.

    Article  PubMed  Google Scholar 

  50. Saha S, Bilchik A, Wiese D, Espinosa M, Badin J, Ganatra BK, et al. Ultrastaging of colorectal cancer by sentinel lymph node mapping technique—a multicenter trial.Ann Surg Oncol 2001; 8 (9 Suppl): 94S-98S.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo

    Hirofumi Fujii & Atsushi Kubo

  2. Department of Surgery, Keio University School of Medicine, Japan

    Yuko Kitagawa & Masaki Kitajima

Authors
  1. Hirofumi Fujii
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  2. Yuko Kitagawa
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  3. Masaki Kitajima
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  4. Atsushi Kubo
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Correspondence to Hirofumi Fujii.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/BF02985011.

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Fujii, H., Kitagawa, Y., Kitajima, M. et al. Sentinel nodes of malignancies originating in the alimentary tract. Ann Nucl Med 18, 1–12 (2004). https://doi.org/10.1007/BF02985608

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