| Budget Amount *help |
¥1,480,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥180,000)
Fiscal Year 2007: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000)
Fiscal Year 2006: ¥700,000 (Direct Cost: ¥700,000)
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| Research Abstract |
This study investigated the availability of fluorescent beads (FB) methods for detecting of sentinel lymph node (SN) for patients with gastric carcinoma (GC). We hypothesized that the fluorescent beads might reflect the flow of cancer cells in lymphatic vessels, because a particulate diameter of the fluorescent beads was similar to a cancer cell.
On the day before surgery, 1ml of FB was injected by an endoscope to four points of submucosal layer around the lesion. Ultraviolet (UV) irradiation was performed during the operation, and extracted lymph nodes were irradiated to detect SN. Light-emitting lymph nodes (LN) were assumed to be SN. At the same time, SN was detected by dye (ICG) methods injected into the subserasal layear from the serosal side surrounding a lesion at the operation time. SN detection was performed for 25 patients with early GC. The SN detection rate was 76% (19/25) in FB methods. The average number of SN was 2.3. The SN detection rate using FB combined with ICG metho
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ds was 92%(23/25). We investigated the distribution of fluorescent beads SN for an early cancer eases according to a primary tumor site. One case in the upper part, SN was detected in compartment I. Fourteen cases in the middle part, SN were detected in compartment I(76%), and compartment II(24%). Five cases in the lower part, the SN were detected in compartment I(88%), and compartment II(12%). We recognized one false-negative case. In that case, the metastatic lymph node was detected out of the area of SN station. The size of tumor in this case was 75×40mm, therefore the large size tumor should not be indicated for SN detection. A metastasis positive case in early cancer was only this false-negative case. We could not reveal the accuracy of FB method because of small number of early gastric cancer. Moreover, it was difficult to detect a fluorescent LN hidden in the adipose tissue during surgery because of autofluorescence of the adipose tissue. For the purpose of application FB to clinical use in the future, a new UV irradiation instrumental should be devised to detect SN during the operation and the FB methods should be combined with other tracer at the same time. Another point should be investigated is a micrometastasis, because it might contribute to the patients prognosis. Therefore we used anticytokeratin (AE1/AE3) for all resected lymph nodes and investigated micrometastasis in 25 early gastric cancer cases. In three cases, we detected micrometastasis. One case of them was situated out of SN station, which was detected by combined FB and dye method. Therefore, we examined whether the presence of micrometastasis influence to the prognosis for gastric cancer cases. However we couldn't recognize the significant difference between positive and negative of micrometastasis. We concluded that the presence of micrometastasis didn't contribute to the poorer prognosis.
From these results, SN navigation surgery could be indicated for early GC by dye or combined FB methods with the lymph nodes dissection of SN station. However, the usefulness of FB method could not be revealed because of our small number of cases. Less
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