Sentinel node mapping for gastric cancer: A prospective multicenter trial in Japan

Yuko Kitagawa, Hiroya Takeuchi, Yu Takagi, Shoji Natsugoe, Masanori Terashima, Nozomu Murakami, Takashi Fujimura, Hironori Tsujimoto, Hideki Hayashi, Nobunari Yoshimizu, Akinori Takagane, Yasuhiko Mohri, Kazuhito Nabeshima, Yoshikazu Uenosono, Shinichi Kinami, Junichi Sakamoto, Satoshi Morita, Takashi Aikou, Koichi Miwa, Masaki Kitajima

Research output: Contribution to journalArticlepeer-review

255 Citations (Scopus)


Purpose: Complicated gastric lymphatic drainage potentially undermines the utility of sentinel node (SN) biopsy in patients with gastric cancer. Encouraged by several favorable single-institution reports, we conducted a multicenter, single-arm, phase II study of SN mapping that used a standardized dual tracer endoscopic injection technique. Patients and Methods: Patients with previously untreated cT1 or cT2 gastric adenocarcinomas < 4 cm in gross diameter were eligible for inclusion in this study. SN mapping was performed by using a standardized dual tracer endoscopic injection technique. Following biopsy of the identified SNs, mandatory comprehensive D2 or modified D2 gastrectomy was performed according to current Japanese Gastric Cancer Association guidelines. Results: Among 433 patients who gave preoperative consent, 397 were deemed eligible on the basis of surgical findings. SN biopsy was performed in all patients, and the SN detection rate was 97.5% (387 of 397). Of 57 patients with lymph node metastasis by conventional hematoxylin and eosin staining, 93% (53 of 57) had positive SNs, and the accuracy of nodal evaluation for metastasis was 99% (383 of 387). Only four false-negative SN biopsies were observed, and pathologic analysis revealed that three of those biopsies were pT2 or tumors > 4 cm. We observed no serious adverse effects related to endoscopic tracer injection or the SN mapping procedure. Conclusion: The endoscopic dual tracer method for SN biopsy was confirmed as safe and effective when applied to the superficial, relatively small gastric adenocarcinomas included in this study.

Original languageEnglish
Pages (from-to)3704-3710
Number of pages7
JournalJournal of Clinical Oncology
Issue number29
Publication statusPublished - 2013 Oct 10

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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