Feasibility and Efficacy of Sentinel Lymph Node Mapping in Gastric Cancer

• Published in: Annals of surgical oncology Vol. 31; no. 10; pp. 6959 - 6969
• Main Authors: Abate, Miseker, Drebin, Harrison, Shimada, Shoji, Fei, Teng, McKinley, Sophia, Poruk, Katherine, Ferguson, Ben, Neuwirth, Madalyn, Tang, Laura H., Vardhana, Santosha, Strong, Vivian E.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2024
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Coloring Agents; Feasibility Studies; Female; Follow-Up Studies; Gastrectomy; Gastrointestinal Oncology; Humans; Indocyanine Green; Lymph Node Excision; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Oncology; Prognosis; Sentinel Lymph Node - pathology; Sentinel Lymph Node - surgery; Sentinel Lymph Node Biopsy - methods; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Lymphadenectomy; Sentinel lymph node mapping; Draining lymph node metastasis; Diagnostic accuracy
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-024-15642-w

Background Lymph node metastasis is a critical prognostic factor for patients with gastric carcinoma (GC). Sentinel lymph node (SLN) mapping has the potential to identify the initial site of draining lymph node metastasis and reduce the extent of surgical lymphadenectomy. This study aimed to evaluate the diagnostic accuracy of SLN mapping in GC. Methods The study enrolled 129 GC patients undergoing total or partial gastrectomy with D2 lymphadenectomy and indocyanine green fluorescence-guided SLN mapping. The primary outcomes were the negative predictive value (NPV) and sensitivity of SLN mapping. The secondary outcomes were clinicopathologic factors associated with SLN mapping accuracy and successful SLN mapping. Results The SLN detection rate in this study was 86.8 %. The study had an overall NPV of 83.1 % and an overall sensitivity of 65.8 %. The NPV was found to be significantly higher in the patients with no lymphovascular invasion (LVI) than in those with LVI (96.0 % vs 59.3 %; p < 0.001) and in the patients whose pathologic T (pT) stage lower than 3 than in those whose T stage was 3 or higher (92.0 % vs 66.7 %; p = 0.009). The sensitivity of SLN mapping was 50 % in the patients with no LVI and 33 % in the patients with a pT stage lower than 3. Conclusion The study results showed that for patients with early-stage GC with no LVI, negative SLN findings may represent a potential additive predictor indicating the absence of regional LN metastasis. However, given the low sensitivity rates noted, further research is needed to identify specific patient populations that may benefit from SLN mapping in GC.