The prognostic value of micrometastases found intraoperatively in the first drainig lymph node in gastric cancer patients.

Background: The concept of sentinel lymph node screening has been recently introduced in gastric cancer treatment. Even through micrometastases can be shown reliably by imunohystochemistry, such staining methods are lengthy and laborious, which precludes its intraoperative use. In this study, the clinical and prognostic implications of a new single sentinel lymph node screening for micrometastases concept were evaluated on a small study group. Methods: Twenty-three patients were included in our study. Nine were selected as a control group. The first stained lymph node was defined as the true sentinel lymph node. This lymph node was sent separately for RT-qPCR analysis to determine CEA and CK-20 expression as markers of micrometastases. Patient and tumor characteristics were analysed and possible correlations with micrometastatic involvement were determined. Results: Fourteen patients were found to be N0. Four patients (28.6 %) had micrometastases. Micrometastases were more prominent in patients with diffuse gastric cancer, with higher CA 19–9 values. Patients with micrometastases were also found to be older than those without them. Conclusions: Even through these results indicate the potential use of a single SNL in intraoperative decision making, the sensitivity and specificity of our method has to be evaluated on a larger series, supported by long-term recurrence and survival results.