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Significance of Metastasis Detected by Molecular Techniques in Sentinel Nodes of Patients with Gastrointestinal Cancer

From the Departments of Surgery (JM, YK, TK, MW, SO, YO, HH, YS, KK MK), Radiology (HF, AK), and Pathology (MM), School of Medicine, and Institute for Advanced Medical Research (KD), Keio University, Tokyo, Japan.

Correspondence: Address correspondence and reprint requests to: Yuko Kitagawa, MD, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan; e-mail: kitagawa{at}sc.itc.keio.ac.jp

ABSTRACT

The clinical significance of micrometastasis in sentinel nodes (SNs) may differ in various organs. In particular, the prognostic value of SN micrometastases detected by reverse transcriptase-polymerase chain reaction (RT-PCR) is still controversial. We investigated the diagnostic and therapeutic significance of nodal molecular metastasis detected by nested RT-PCR for cytokeratin (CK) 19 mRNA in gastrointestinal cancer. In 51 cases with GI tract cancer treated by standard curative resection, SNs were identified by a radio-guided method. In 10 of 51 patients, 25 SNs and 3 non-SNs were histologically negative and RT-PCR positive. Three non-SNs with positive CK19 mRNA were randomly sampled from the same basin where histologically positive SNs were identified. Immunohistochemical analysis of six additional step sections obtained at 30-µm intervals with use of an anticytokeratin antibody showed clearly recognizable histological metastases in 4 of 25 histologically negative/RT-PCR-positive SNs (16%). In one case of esophageal squamous cell carcinoma with nodal micrometastasis identified by CK19 RT-PCR, extranodal local recurrence in the SN basin (left supraclavicular basin) was observed 6 months postoperatively. These findings suggest that nodal micrometastasis detected by nested RT-PCR has some clinical significance in GI cancer. Molecular assessment of the SN may be a valuable tool to complement routine histological examination for GI cancers.

Key Words: Colorectal cancer • Esophageal cancer • Gastric cancer • Sentinel node • Micrometastasis • RT-PCR

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