Therefore, dye method alone may not be suitable for SLN mapping in oesophageal cancer (35).

With the use of three selleck kinase inhibitor serial sections and immunohistochemistry on negative SLNs, 14% (3/22) of http://www.selleckchem.com/products/Sorafenib-Tosylate.html patients were upstaged (35) and Lamb et al. also found that 12% (3/25) of pN0 patients were upstaged following immunohistochemistry Inhibitors,research,lifescience,medical analysis (27). The routine use of SLN biopsy in oesophageal cancer cannot alter or limit the extent of lymphadenectomy in the same way as is seen in breast cancer and melanoma. And in oesophageal cancer, preoperative access to sentinel nodes may be as invasive, and as morbid, as the operation itself. But, if one agrees that isolated tumour cells have prognostic significance in oesophageal cancer and are detected in 12-14% of node-negative patients using serial sections and immunohistochemistry, then the SLN concept becomes the only practical method of improving pathological staging

(35). So, although sentinel node biopsy has not yet Inhibitors,research,lifescience,medical been shown to minimize the extent of lymphadenectomy, it may influence postoperative therapy for a substantial number of patients. Perhaps the key drawback with SLN biopsy in oesophageal cancer is the variety of SLN tracer authorized Inhibitors,research,lifescience,medical for clinical use in each nation (54). The vastly diverse particle sizes hinder wide application of the model and design of a uniform practice. For instance, Japan’s 99mTc-tin colloid (100 nm in size) Inhibitors,research,lifescience,medical allows for lymphoscintigraphy 24 h before surgical resection (23), while other smaller radio colloids (like Australia’s 99mTc-antimony trisulphide colloid) have much shorter transit periods in the sentinel nodes (54,55). We observed that Inhibitors,research,lifescience,medical the parameters like sensitivity, accuracy and detection rates were higher in radioisotopes

when compared to methylene blue or patent blue dyes (Table 6). Facilitating preoperative lymphoscintigraphy in between endoscopic peritumoural injection and same-day surgery is often not practical. Table 6 Information about the particle property, injection technique and pathological analysis Skip metastases Another criticism in the literature GSK-3 about SLN biopsy in oesophageal cancer is the described high frequency of skip metastases, although most of these outcomes have been in patients with squamous cell carcinomas (27,35). If SLNs without metastasis are identified only in abdominal lymph nodes, especially in the tumours limited to the lower third of the oesophagus, cervical lymph nodes dissection may be omitted, such as left thoracotomy or trans-hiatal approach. SLN navigation surgery also is unacceptable for patients who have had neoadjuvant therapy (25). Limitations The studies included in the meta-analysis are predominantly from Japan and hence generalization of such results cannot be made.