Sentinel node navigation surgery for gastric cancer: Overview and perspective

Table 1 Cinical trials that validated the importance of sentinel lymph node surgery for gastric cancer in a current decade

Ref.	Year	n	Detection rate (%)	Sensitivity (%)	Main results
Kitagawa et al[19]	2014	397	97.50	93.00	The proportion of false negatives was 46% (13/28) after a learning period. False negatives remained at 14% (4/28) even by examining additional sections of GNs by paraffin section
Stojanovic et al[60]	2013	137	98.20	100	Highly successful mapping and biopsy of SLNs, as well as highest sensitivity was demonstrated and IHC study might enable “ultra staging”
Dong et al[61]	2012	23	100	100	SLN-guided minimally invasive surgery could be safely performed in EGC according to feasible criteria
Park do et al[62]	2011	68	91.20	100	Simultaneous ICG and (99m)Tc-ASC-guided laparoscopic sentinel basin dissection is an effective tool for gastric cancer SN mapping
Kelder et al[34]	2010	212	99.50	97.00	LBD dissection based on IREE is a safe method of nodal dissection in patients with T1 or limited T2 tumors
Tajima et al[22]	2009	56	96.40	T1; 97.2 T2 or T3; 72.2	SN mapping guided by ICG fluorescence imaging is useful for predicting the metastasis in lymph nodes in gastric cancer with cT1-stage cancer
Rino et al[63]	2007	43	93.00	100	SN mapping seems sufficient in T1 or T2 gastric cancer
Morita et al[66]	2007	53	100	82	The accuracy of the SNNS procedure for detecting SNs in patients with early gastric cancer was 96% at the occult metastasis level
Ichikura et al[67]	2006	80	100	93	Dissecting the lymph node stations only where the tracers are distributed is recommended for patients with no metastatic SNs
Zulfikaroglu et al[64]	2005	32	97	100	SLN biopsy using gamma probe in gastric cancer is a feasible procedure with high sensitivity and accuracy

SLN: Sentinel lymph node; EGC: Early gastric cancer; ICG: Indocyanine green; LBD: Lymphatic basin dissection; IREE: Infrared ray electronic endoscopy; SNNS: Sentinel node navigation surgery.

Table 2 Cinical trials that served to focus on the limitation of sentinel lymph node surgery for gastric cancer in a current decade

Ref.	Year	n	Detection rate (%)	Sensitivity (%)	Main results
Miyashiro et al[40]	2014	440	97.80	46% of false negative rate	The proportion of false negatives was 46% (13/28) after a learning period. False negatives remained at 14% (4/28) even by examining additional sections of GNs by paraffin section
Ryu et al[41]	2011	2684	87.80	97.50	A meta-analysis of feasibility studies showed SNB in gastric cancer may not be clinically applicable due to the unsatisfactory sensitivity and heterogeneity among practicing surgeons
Wang et al[11]	2011	2128	93.70	76.90	The reliability of SNLB in EGC is currently not comparable to SNLB in breast cancer or melanoma
Becher et al[8]	2009	27	100.00	83.00	The negative predictive value is 75% and clinical use of SN mapping for gastric cancer was not recommended
Yanagita et al[56]	2008	133	98.50	100.00	Micrometastasis and ITCs should be removed, especially during SN navigation surgery
Tonouchi et al[65]	2005	37	94.60	75.00	During laparoscopic SN mapping there is a high risk of false negativity with SNs located in the right pericardial region

GN: Green node; EGC: Early gastric cancer; ITCs: Isolated tumor cells; SNB: Sentinel node biopsy; SNLB: Sentinel lymph node biopsy; ITCs: Isolated tumor cells.