Initial Experience with Sentinel Lymph Node Biopsy for Esophageal Cancer

Introduction: There is emerging evidence that isolated tumor cells and micrometastases in lymph nodes have prognostic value in esophageal cancer. To facilitate a detailed examination of a limited number of lymph nodes by the pathologist, we report our initial experience with sentinel lymph node biopsy in patients undergoing resection for invasive esophageal cancer.

Methods: Ten consecutive patients underwent resection for invasive esophageal cancer along with sentinel lymph node retrieval. Peritumoral injection of 1 ml aliquots to a maximum of 40 MBq 99mTc antimony nanocolloid was performed by upper endoscopy immediately prior to the operation. A 2-surgeon synchronous approach via a right thoracotomy and laparotomy was performed. Sentinel lymph nodes were identified with a gamma probe (gammasonics MK2) both in and ex vivo. Sentinel lymph nodes were sent off separately for serial sections and immunohistochemistry.

Results: The median patient age was 59.1 years (range, 45-70 years). Eight patients were male, and nine of the ten had an esophageal adenocarcinoma. Nine patients successfully underwent resection, and of those, two patients had received neoadjuvant therapy. At least one sentinel lymph node (average, 2.6) was identified in 7 of 9 patients (78%). In all 7 patients, the sentinel lymph node(s) accurately predicted nodal status (accuracy 100%). After immunohistochemical analysis, one patient had occult tumor cells in their sentinel lymph node.

Conclusions: Sentinel lymph node biopsy is feasible in esophageal cancer, and is accurate in predicting overall nodal status. A learning curve exists in identifying sentinel lymph nodes, especially when performing a conservative lymphadenectomy.

Session: Podium Presentation

Program Number: S067

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