Detection of sentinel and non-sentinel lymph node micrometastases by complete serial sectioning and immunohistochemical analysis for gastric cancer

Kaname Ishii , Shinichi Kinami , Kenichiro Funaki , Hideto Fujita , Itasu Ninomiya , Sachio Fushida , Takashi Fujimura , Genichi Nishimura and Masato Kayahara

Department of Gastroenterologic Surgery, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan

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Journal of Experimental & Clinical Cancer Research 2008, 27:7doi:10.1186/1756-9966-27-7


Published:	30 May 2008

Abstract

Background

We investigated the presence and distribution of the sentinel and the non-sentinel node micrometastases using complete serial sectioning and immunohistochemical staining (IHC), to inspect whether lymph node micrometastases spread to the sentinel lymph nodes first.

Methods

A total of 35 patients, who underwent gastrectomy with a sentinel lymph node biopsy for gastric cancer, were enrolled in this study. Total of 1028 lymph nodes of 35 patients having gastric cancer without metastasis of lymph node by permanent section with hematoxylin and eosin staining (H&E) were selected. There were 252 sentinel nodes and the other 776 were non-sentinel nodes. All nodes were sectioned serially and stained alternately with H&E and IHC. Lymph node micrometastases was defined as proving to be positive first either the IHC or the complete serial sectioning.

Results

Micrometastases were detected in 4 (11%) of the 35 patients, 6 (0.58%) of 1028 nodes. Of these 4 patients, 3 had micrometastases exclusively in sentinel nodes, and the other had micrometastasis in both sentinel and non-sentinel nodes. There was no patient who had the micrometasitases only in non-sentinel nodes.

Conclusion

These results support the concept that lymph node micrometastasis of gastric cancer spreads first to sentinel nodes.