Sentinel lymph node biopsy predicts lymph node metastasis in early gastric cancer: a retrospective analysis.

Background/aims: Minimally invasive treatments have emerged as the frontline therapy for patients with early gastric cancer (EGC). However, some cT1N0 patients with EGC may have lymph node metastasis because of inadequate evaluation. This study aimed to investigate the diagnostic accuracy of sentinel lymph node (SLN) and tried to find out feasible criteria for SLN-guided minimally invasive surgery for EGC.

Methods: A solitary metastasis lymph node was taken as SLN, the features of lymph node metastasis were analyzed retrospectively in 255 patients with EGC, and the result was then compared with a SLN biopsy in 23 patients with EGC.

Results: Depth of invasion and tumor size were independent risk factors for lymph node metastasis in EGC. The lymph node metastasis rate for mucosal carcinoma with a diameter <4 cm was 2.5%, and it was 13.3% when the diameter was ≥ 4 cm (p = 0.040). For submucosal carcinoma, it was 25.4% when the tumor diameter was <3 cm and 50.5% when the diameter was ≥ 3 cm (p = 0.003). The accuracy, sensitivity, and specificity of SLN biopsy in EGC was 100%, respectively. The distribution characteristics of SLN were consistent with those of lymph node metastasis in EGC.

Conclusions: SLN-guided minimally invasive surgery could be safely performed in EGC according to feasible criteria.