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Presurgical Lymphoscintigraphic Mapping to Identify Sentinel Lymph Nodes by Multiple-Angle Projection Method in Gastroenteric Cancer

Background: Sentinel lymph node biopsy plays a pivot role in nodal staging in surgical oncology. Because of the complicated lymphatic drainage system around the gastroenteric region, it is often difficult to localize and identify the sentinel nodes clinically. In this study, we proposed the use of presurgical lymphoscintigraphic mapping by multiple-angle projection (MAP) method to enhance the detection of sentinel nodes. Methods: Thirty-one patients who were diagnosed with gastric or colorectal cancer were enrolled in this study. All of them received a submucosal injection of either 1-mCi (superscript 99m)Tc-sulfur colloids ((superscript 99m)Tc-SC) or (superscript 99m)Tc-phytate via endoscope, three hours after the injection, 180 or 360 degrees arc multiple-angle projections acquisition, two imaging protocols were applied to gastric or colorectal cancer patients, respectively. On the basis of the mapping location, sentinel lymph node biopsy was performed the next day by probe identification during surgery. Results: A total of thirty-one patients were enrolled in this study, 13 of them had gastric cancer and 18 of them had colorectal cancer. Most of the enrolled patients were staged within T2-T3 cancer. Sixty-two percent of the gastric cancer patients and 39% of the colorectal cancer patients had detectable sentinel lymph nodal activity on multiple-angle projection mapping image. Of those with detectable nodal activity, there was not only a good correlation between tumor location and sentinel lymph nodal distribution, but also good marking numbers of regional involved sentinel nodes in different orientation via multiple-projection mapping image. Reconstruction techniques need to be developed in the future. Conclusion: Presurgical lymphoscintigraphic mapping by multiple-angle projection method is an adjuvant technique to provide 3-D information and localize the sentinel lymph nodes in gastroenteric cancer.