Jun Yan1, Xiaoling Zheng2, Fangqin Xue2, Yu Zheng2, Jiang Yu1, Feng Chen3, Hong Shi3, Gang Chen4, Jianping Lu4, Lisheng Cai5, Mingzhi Cai5, Gao Xiang6, Zhenwei Deng1, Guoxin Li1. 1Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong,, 2Department of Surgery, Fujian Provincial Hospital, Teaching Hospital of Fujian Medical University, 3Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical Uni, 4Department of Pathology, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical Unive, 5Department of Surgery, Zhangzhou Hospital, Teaching Hospital of Fujian Medical University, 6Department of Surgery, Nanping Hospital, Teaching Hospital of Fujian Medical University
Lymph node metastasis occurs in approximate 10% of early gastric cancer. Pre-operative 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.
A multi-center study was performed between July 2012 and July 2014. Ninety one patients with early gastric cancer identified by pre-operative endoscopic ultrasonography (EUS) 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 to 12 hours before surgery (Fig.A, B). 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.
All patients had black-dyed SLNs lying in greater omentum and/or lesser omentum. SLNs were easily found under laparoscopy (Fig.C). The mean number of SLNs was 4 (range = 1–9). Carbon nanoparticles were around cancer in specimen (Fig.D). 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 (Fig.E). When SLNs were positive, cancer cells were seen in lymph nodes (Fig.F). The sensitivity, specificity, accuracy of black-dyed SLNs in early gastric cancers was 90%, 100%, 98.9%, respectively. No patient had any side effects of carbon nanoparticles in this study.
It is feasible to use carbon nanoparticles to show SLNs in early gastric cancer. Carbon nanoparticles suspension is safe for submucosal injection.
Carbon nanoparticles; Sentinel lymph nodes; Early gastric cancer; Lymph node metastasis; Multi-center study.