PT - JOURNAL ARTICLE AU - Huib A. Cense AU - Gerrit W. Sloof AU - Joost M. Klaase AU - Jacques J. Bergman AU - Formijn J. van Hemert AU - Paul Fockens AU - Jan J.B. van Lanschot TI - Lymphatic Drainage Routes of the Gastric Cardia Visualized by Lymphoscintigraphy DP - 2004 Feb 01 TA - Journal of Nuclear Medicine PG - 247--252 VI - 45 IP - 2 4099 - http://jnm.snmjournals.org/content/45/2/247.short 4100 - http://jnm.snmjournals.org/content/45/2/247.full SO - J Nucl Med2004 Feb 01; 45 AB - This study was undertaken to assess the feasibility of lymphoscintigraphy of the gastric cardia and to identify the incidence of paraesophageal lymphatic drainage, precluding total gastrectomy with esophagojejunostomy as a potentially curative therapy for gastric cardia cancer. Methods: Ten patients scheduled for esophagectomy with high-grade dysplasia or with esophageal cancer at least 3 cm above the esophagogastric junction were enrolled in this study. Preoperatively, 111 MBq of99mTc-labeled nanocolloid (n = 5) or sulfur colloid (n = 5) were injected into the submucosa of the tumor-free cardia. Subsequently, lymphoscintigraphy in combination with CT was obtained. Locoregional lymph node stations were measured for radioactivity by a γ-probe intraoperatively and ex vivo in the resection specimen. Results: In each patient, at least 1 radioactive lymph node station was detected. In total, 42 radioactive lymph node stations were detected by γ-probe. Of those 42 areas, 38 (90%) were visible at preoperative lymphoscintigraphy. In the group of 5 patients in whom nanocolloid was used, a median of 2 (range, 1–4) node stations per patient was identified, whereas when sulfur colloid was administered a median of 6 (range, 4–8) active lymph node stations per patient could be detected (P < 0.002). Paraesophageal drainage was identified in 1 patient. Conclusion: Lymphoscintigraphy of the gastric cardia is feasible and can accurately determine the location of radioactive lymph nodes. Early paraesophageal lymphatic drainage is rare.