SENTINEL LYMPH NODES AND LYMPHATIC BASIN BY THE DYE-GUIDED METHOD IN EARLY GASTRIC CANCER BASED ON IMMUNOHISTOCHEMICAL ANALYSIS OF MICROMETASTASES

色素法によるセンチネルリンパ節 (sentinel node ; SN) を指標としたリンパ節転移診断の問題点を微小転移の観点から検討した. 早期胃癌57例を対象に, 色素法によるSNおよびセンチネルリンパ流 (Sentinel lymphatic basin, SB) 同定率, SNおよびSBを指標とした微小転移を含む転移検出感度, 正診率を検討した. 微小転移は癌細胞1個をtumor cell microinvolvement, cluster形成をtumor clusterと定義した. M癌では2.9% (1/34), SM癌では60.9% (14/23) に微小転移を認めた. 微小転移を指標としたSN同定率は100%, 感度60.0%, 正診率89.5%と感度が低く, 一方SB単位で検討すると感度は86.7%, 正診率96.5%と良好であった. 早期胃癌におけるリンパ節微小転移頻度は高く, SNを指標とした場合の偽陰性症例の頻度を考慮すると, 現状ではSNを指標とするよりもSBを指標とした方がより安全性の高い縮小手術が可能であると考えられた.

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