caa a22 4500 445334010 CHVBK 20180317142747.0 cr unu---uuuuu 170323e20110701xx s 000 0 eng 10.1245/s10434-011-1713-4 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1713-4 Combination of Ex Vivo Sentinel Lymph Node Mapping and Methylene Blue-Assisted Lymph Node Dissection in Gastric Cancer: A Prospective and Randomized Study [Elektronische Daten] [Bruno Märkl, Alexandra Moldovan, Hendrik Jähnig, Claudio Cacchi, Hanno Spatz, Matthias Anthuber, Daniel Oruzio, Hallie Kretsinger, Hans Arnholdt] Background: Exact lymph node (LN) staging is crucial for prognosis estimation and treatment stratification in gastric cancer. Recently, a new concept for improving LN harvest and the accuracy of LN staging was introduced. It combines methylene blue-assisted lymph node dissection (MBLND) with a new ex vivo sentinel lymph node (evSLN) mapping technique. The purpose of this study was to investigate these techniques in a prospective and randomized manner. Methods: A total of 50 patients with proven or suspicious gastric cancer were enrolled. Twenty-five patients each were randomized to the conventional technique (Unstained) or MBLND (Methylene). In 46 cases, additional evSLN mapping with black ink as a marker dye was performed. Results: Methylene blue-assisted lymph node dissection was associated with a highly significantly improved LN harvest (36±10 vs. 21±10; P<0.001). The biggest differences were seen in LNs≤6mm. In contrast to the conventional technique, neither partial gastrectomy nor preoperative chemotherapy influenced LN harvest in the methylene group. The evSLN detection rate, sensitivity, and accuracy were 87, 81, and 93%, respectively. Isolated tumor cells were detected after immunohistochemical staining in 3 of 17 cases (18%). The probability of carrying a metastasis was two times higher in evSLNs compared to non-evSLNs (44 vs. 23%; P<0.001). Conclusions: Methylene blue-assisted lymph node dissection is a highly effective method of improving the LN harvest in gastric cancer. Further application of evSLN mapping is feasible and has the potential to heighten the sensitivity of metastasis detection. Society of Surgical Oncology, 2011 Märkl Bruno Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut Moldovan Alexandra Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut Jähnig Hendrik Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut Cacchi Claudio Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut Spatz Hanno Department of Visceral Surgery, Klinikum Augsburg, Augsburg, Germany aut Anthuber Matthias Department of Visceral Surgery, Klinikum Augsburg, Augsburg, Germany aut Oruzio Daniel II. Medical Clinic, Klinikum Augsburg, Augsburg, Germany aut Kretsinger Hallie Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut Arnholdt Hans Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut Annals of Surgical Oncology Springer-Verlag 18/7(2011-07-01), 1860-1868 1068-9265 18:7<1860 2011 18 10434 https://doi.org/10.1245/s10434-011-1713-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1713-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Märkl Bruno Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut NATIONALLICENCE 700 1- Moldovan Alexandra Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut NATIONALLICENCE 700 1- Jähnig Hendrik Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut NATIONALLICENCE 700 1- Cacchi Claudio Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut NATIONALLICENCE 700 1- Spatz Hanno Department of Visceral Surgery, Klinikum Augsburg, Augsburg, Germany aut NATIONALLICENCE 700 1- Anthuber Matthias Department of Visceral Surgery, Klinikum Augsburg, Augsburg, Germany aut NATIONALLICENCE 700 1- Oruzio Daniel II. Medical Clinic, Klinikum Augsburg, Augsburg, Germany aut NATIONALLICENCE 700 1- Kretsinger Hallie Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut NATIONALLICENCE 700 1- Arnholdt Hans Institute of Pathology, Klinikum Augsburg, Augsburg, Germany aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/7(2011-07-01), 1860-1868 1068-9265 18:7<1860 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer