Preoperative lymphoscintigraphy for detection of sentinel lymph node in patients with gastric cancer--initial experience.

Abstract

Preoperative lymphoscintigraphy may be informative when assessing nodal status in patients with early gastric cancer, especially for surgeons who are scheduled to introduce or have just introduced SLN biopsy. A total of 80 patients with clinical T1N0M0 gastric cancer were injected with technetium-99 m tin-colloid and then underwent preoperative lymphoscintigraphy. The detection rate of SLN per lymphatic basin was determined on the basis of the results of confirmatory lymph node dissection. By means of lymphoscintigraphy, 71 of 106 basins were found (67%; 95% confidence interval [CI], 57.2-75.9%). Patients were stratified into the following subgroups: successful (S; all basins visualized), partially successful (PS; some basins visualized), and unsuccessful (U; none visualized). The body mass index (BMI) was significantly higher in the U (24.0 +/- 2.5) than in the S (22.3 +/- 2.4) group (P = 0.037). All patients in the U group had a single basin. Multivariate analysis showed that BMI was associated with unsuccessful lymphoscintigraphy (OR, 1.43; 95% CI, 1.06-1.92; P = 0.019), whereas all factors were similar between the S and PS groups. BMI affects SLN detection during lymphoscintigraphy. Unsuccessful lymphoscintigraphy suggests that SLNs are located in a single basin. When lymphoscintigraphy is positive, no preoperative factors can predict whether all lymphatic basins can be visualized.