Jun Yan1,2, Xiaoling Zheng3,4, Zhangyuanzhu Liu3, Jiang Yu3, Zhenwei Deng3, Fangqing Xue3,4, Yu Zheng3,4, Feng Chen5, Hong Shi5, Gang Chen6, Jianping Lu6, Lisheng Cai7, Mingzhi Cai7, Gao Xiang8, Yunfeng Hong9, Wenbo Chen9, Guoxin Li10. 1. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China. ynjun@yahoo.com. 2. Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350014, Fujian, People's Republic of China. ynjun@yahoo.com. 3. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China. 4. Department of Surgery, Fujian Provincial Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China. 5. Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350014, Fujian, People's Republic of China. 6. Department of Pathology, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350014, Fujian, People's Republic of China. 7. Department of Surgery, Zhangzhou Hospital, Teaching Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian, People's Republic of China. 8. Department of Surgery, Nanping Hospital, Teaching Hospital of Fujian Medical University, Nanping, 353000, Fujian, People's Republic of China. 9. Department of Surgery, Nan'an Hospital, Teaching Hospital of Fujian Medical University, Nan-an, 362300, Fujian, People's Republic of China. 10. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China. gzliguoxin@163.com.
Abstract
BACKGROUND: Lymph node metastasis occurs in approximately 10% of early gastric cancer. Preoperative or intra-operative identification of lymph node metastasis in early gastric cancer is crucial for surgical planning. The purpose of this study was to evaluate the feasibility of using carbon nanoparticles to show sentinel lymph nodes (SLNs) in early gastric cancer. METHODS: A multicenter study was performed between July 2012 and November 2014. Ninety-one patients with early gastric cancer identified by preoperative endoscopic ultrasonography were recruited. One milliliter carbon nanoparticles suspension, which is approved by Chinese Food and Drug Administration, was endoscopically injected into the submucosal layer at four points around the site of the primary tumor 6-12 h before surgery. Laparoscopic radical resection with D2 lymphadenectomy was performed. SLNs were defined as nodes that were black-dyed by carbon nanoparticles in greater omentum and lesser omentum near gastric cancer. Lymph node status and SLNs accuracy were confirmed by pathological analysis. RESULTS: All patients had black-dyed SLNs lying in greater omentum and/or lesser omentum. SLNs were easily found under laparoscopy. The mean number of SLNs was 4 (range 1-9). Carbon nanoparticles were around cancer in specimen. After pathological analysis, 10 patients (10.99%) had lymph node metastasis in 91 patients with early gastric cancer. SLNs were positive in 9 cases and negative in 82 cases. In pathology, carbon nanoparticles were seen in lymphatic vessels, lymphoid sinus, and macrophages in SLNs. When SLNs were positive, cancer cells were seen in lymph nodes. The sensitivity, specificity, and accuracy of black-dyed SLNs in early gastric cancers were 90, 100, and 98.9 %, respectively. No patient had any side effects of carbon nanoparticles in this study. CONCLUSIONS: It is feasible to use carbon nanoparticles to show SLNs in early gastric cancer. Carbon nanoparticles suspension is safe for submucosal injection.
BACKGROUND: Lymph node metastasis occurs in approximately 10% of early gastric cancer. Preoperative or intra-operative identification of lymph node metastasis in early gastric cancer is crucial for surgical planning. The purpose of this study was to evaluate the feasibility of using carbon nanoparticles to show sentinel lymph nodes (SLNs) in early gastric cancer. METHODS: A multicenter study was performed between July 2012 and November 2014. Ninety-one patients with early gastric cancer identified by preoperative endoscopic ultrasonography were recruited. One milliliter carbon nanoparticles suspension, which is approved by Chinese Food and Drug Administration, was endoscopically injected into the submucosal layer at four points around the site of the primary tumor 6-12 h before surgery. Laparoscopic radical resection with D2 lymphadenectomy was performed. SLNs were defined as nodes that were black-dyed by carbon nanoparticles in greater omentum and lesser omentum near gastric cancer. Lymph node status and SLNs accuracy were confirmed by pathological analysis. RESULTS: All patients had black-dyed SLNs lying in greater omentum and/or lesser omentum. SLNs were easily found under laparoscopy. The mean number of SLNs was 4 (range 1-9). Carbon nanoparticles were around cancer in specimen. After pathological analysis, 10 patients (10.99%) had lymph node metastasis in 91 patients with early gastric cancer. SLNs were positive in 9 cases and negative in 82 cases. In pathology, carbon nanoparticles were seen in lymphatic vessels, lymphoid sinus, and macrophages in SLNs. When SLNs were positive, cancer cells were seen in lymph nodes. The sensitivity, specificity, and accuracy of black-dyed SLNs in early gastric cancers were 90, 100, and 98.9 %, respectively. No patient had any side effects of carbon nanoparticles in this study. CONCLUSIONS: It is feasible to use carbon nanoparticles to show SLNs in early gastric cancer. Carbon nanoparticles suspension is safe for submucosal injection.
Authors: M Hiratsuka; I Miyashiro; O Ishikawa; H Furukawa; K Motomura; H Ohigashi; M Kameyama; Y Sasaki; T Kabuto; S Ishiguro; S Imaoka; H Koyama Journal: Surgery Date: 2001-03 Impact factor: 3.982
Authors: Y Kitagawa; H Fujii; M Mukai; T Kubota; N Ando; M Watanabe; M Ohgami; Y Otani; S Ozawa; H Hasegawa; T Furukawa; K Kumai; T Ikeda; T Nakahara; A Kubo; M Kitajima Journal: Surg Clin North Am Date: 2000-12 Impact factor: 2.741
Authors: E Orsenigo; V Tomajer; S Di Palo; L Albarello; C Doglioni; E Masci; E Viale; C Staudacher Journal: Surg Endosc Date: 2007-05-05 Impact factor: 4.584