위암 환자에서 방사선 동위 원소를 이용한 감시림프절 생검의 초기 경험
Preliminary Study for Sentinel Lymph Node Biopsy with 99MTc Tin-Colloid in Patients with Gastric Cancer
김민찬, 박기재, 조세헌, 정갑중, 이종훈, 최석렬, 강도영, 정진숙, 박한석,
소속 상세정보
김민찬 ( Kim Min-Chan )
동아대학교 의과대학 외과학교실
박기재 ( Park Ki-Jae )
동아대학교 의과대학 외과학교실
조세헌 ( Joh Se-Heon )
동아대학교 의과대학 외과학교실
정갑중 ( Jung Ghap-Joong )
동아대학교 의과대학 외과학교실
이종훈 ( Lee Jong-Hoon )
동아대학교 의과대학 내과학교실
최석렬 ( Choi Seok-Reyol )
동아대학교 의과대학 내과학교실
강도영 ( Kang Do-Young )
동아대학교 의과대학 핵의학교실
정진숙 ( Jeong Jin-Sook )
동아대학교 의과대학 병리학교실
박한석 ( Park Han-Suk )
동아대학교 의과대학 마취과학교실
KMID : 0371320020630020129
Abstract
Purpose: The sentinel lymph node (SLN) is defined as the first draining node from the primary lesion and it would be the first site of metastasis. The objective of this study was to determine the feasibility of an SLN biopsy in patients
with
gastric cancer for the assessment of the lymph node status.
Methods: From November 2001 through to March 2002, SLN biopsies were performed in fourteen consecutive patients whose preoperative imaging studies showed T2 or T1 and no lymph node metastases. Three hours prior to
each
operation, a 99mTc tin-colloid (2.0 ㎖, 1.0 mCi) was injected via endoscopy into the patient’s gastric submucosa. Subsequently a lymphoscintigraphy was performed serially using a dual head gamma camera. After a SLN biopsy had been
performed
using the gamma probe (NEO2000™ Gamma Detection System, Neoprobe CO, 1999, USA), all the patients underwent a radical gastrectomy (D2+α). The SLN was cut into three pieces for a frozen sample, H&E and immunohistochemistry
(IHC)
staining.
Results: The location of all the SLNs was in the perigastric area. No skip metastases were found. SLNs were identified in 12 of the 14 patients (success rate, 85.7%). Of these 12 patients, 6 had lymph node metastases in SLNs or Non- SLNs,
or
both; 3 in both SLNs and non-SLNs; 2 in SLNs alone; and 1 in non-SLNs alone. The sensitivity of the SLN status in the diagnoses of the lymph node status of the patient was 82.2% (5/6) and the specificity was 100.0% (6/6). The diagnostic accuracy
according to SLN status was 91.7% (11 of 12).
Conclusion: SLN biopsies using a radioisotope in patients with gastric cancer are a technically feasible and accurate technique; they are a minimally invasive approach in the assessment of the node status of patients with gastric cancer.
키워드
감시림프절생검; 위 악성종물; 림프절 전이; Sentinel lymph node biopsy; Stomach neoplasm; Lymphatic metastasis;
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