Sentinel node identification using technetium-99m neomannosyl human serum albumin in esophageal cancer

Background: This study is a clinical trial designed to test the reliability and feasibility of sentinel node detection using a new mannose receptor radioactive binding agent in patients with esophageal squamous cell carcinoma. Methods: Twenty-three patients (21 men, 2 women; mean age 61.0±8.60 years) who were candidates for esophagectomy with conventional lymph node dissection for thoracic esophageal cancer were enrolled. A total dose of 1mCi of ^99mTc-MSA [technetium-99m neomannosyl human serum albumin] in 0.2 mL was administered at 4 quadrants into the submucosal layer around the primary tumor under esophagoscopic guidance approximately 1 hour before surgery. Intraoperative sentinel node sampling was subsequently followed by esophagectomy. All harvested lymph nodes were cut into 2-mm slices and ultimately diagnosed using formalin-fixed and paraffin-embedded sections with hematoxylin and eosin staining. Results: The number of dissected lymph nodes per patient was 30.5 ± 9.18 (1547). Among 23 patients, the sentinel lymph nodes could be identified in 21 patients (91.3%). The sentinel nodes could be identified in all 21 patients with cT1 or T2N0M0 (100%) disease; these patients were candidates for sentinel lymph node navigation surgery for the esophageal cancer. The mean number of sentinel nodes identified was 2.6 ± 1.35 (range, 15) per patient. No false-negative sentinel lymph nodes were detected in any of the 8 patients with node-positive disease (0%). Conclusions: Intraoperative sentinel lymph node identification using ^99mTc-MSA was feasible and reliable in patients with esophageal squamous cell carcinoma.