Usefulness of the TRC method in the peritoneal washing cytology for gastric cancer.

BACKGROUND: Peritoneal dissemination from gastric cancer is the most frequent metastasis of advanced gastric cancer. Detection of cancer micrometastasis is required for improvement of cancer therapy. A method that can detect micrometastases more sensitively is desired. Against this background, for the purposes of making the genetic diagnosis of micrometastasis simple and rapid, TRC (transcription reverse transcription concerted reaction) was developed. METHODOLOGY: 69 patients with gastric cancer in those diagnosed with deeper than mp. At the time of surgery, peritoneal washing with saline was extracted. Having extracted the RNA therein, It was blended with a reagent responsive to CEAmRNA and was put into TRC. The cytology and TRC were compared and studied. RESULTS: The concordance rate between TRC and cytology was K=0.6552. The patients whom there was a discrepancy between the cytology and TRC are clinically validate the TRC results. In the study of prognosis, TRC obtained a sensitivity of 90.9% and a specificity of 98.3%. CONCLUSION: The measurement of CEAmRNA in peritoneal washing specimens by the TRC method is superior to Cytology. That is also equal to or superior to the RT-PCR method with respect to sensitivity and specificity, and superior with respect to simplicity and rapidity.

Intraoperative diagnosis of lymph node metastasis by transcription-reverse transcription concerted reaction assay in gastric cancer.

BACKGROUND: Increasing evidence has been accumulated to substantiate the clinical usefulness of quantitative evaluation of gene expression. This study was undertaken to assess diagnosis of metastasis in dissected lymph nodes through quantitative evaluation of the expression of carcinoembryonic antigen mRNA (CEA mRNA) by a rapid, simple transcription-reverse transcription concerted reaction (TRC) assay using dissected lymph node washings. METHODS: A total of 110 dissected lymph nodes from 40 patients undergoing surgery for gastric cancer were studied. Each dissected lymph node was cut crosswise and washed with physiological saline. The washings were assayed for CEA mRNA and the assay results were assessed in comparison with the pathological diagnosis [hematoxylin and eosin (H&E) staining]. All lymph nodes were also subjected to immunostaining for cytokeratin (CK staining) and assessed comparatively. RESULTS: By H&E staining, 29 lymph nodes were found to be positive and 81 to be negative for metastasis. By TRC assay, 38 lymph nodes were found to be positive and 72 to be negative. According to the results of CK staining, there were 37 metastasis-positive lymph nodes and 73 negative nodes. The sensitivity and specificity of H&E staining relative to those of CK staining were 78.4 and 100 %, respectively, while the sensitivity and specificity of TRC assay relative to those of CK staining were 91.9 and 94.5 %, respectively. CONCLUSIONS: The TRC assay method using lymph node washings is a rapid, simple genetic diagnosis with greater sensitivity than conventional diagnosis by H&E staining of permanent specimens, and enables conservation of lymph nodes in toto as permanent specimens. This TRC method would enable rapid diagnosis even in town hospitals where no pathologist is ordinarily stationed, and is considered to contribute to the clinical application of the sentinel node theory of gastric cancer treatment.

Clinical outcome of esophagogastrostomy after proximal gastrectomy for gastric cancer.

BACKGROUND/AIMS: In order to prevent reflux esophagitis after proximal gastrectomy, reconstruction by jejunal interposition (EJ) is often performed; however, this procedure is considered to be extremely complex. The purpose of this research is to consider the indication and usefulness of esophagogastrostomy (EG), as a less-invasive method of reconstruction. METHODOLOGY: From 1999, 64 proximal gastrectomy cases have been reviewed. In 46 cases, EG combined with a reflux prevention procedure was performed while in the remaining 18 cases, EJ was performed. An endoscopic examination was conducted 1 year after surgery in all cases. RESULTS: Compared to EJ, EG required less surgical time, thus resulting in less blood loss. Reflux esophagitis was frequently present in the EG cases (22 vs. 11%). In the EG group, 36 cases involving abdominal esophagus (AE) conservation due to the site of the cancer in comparison to the resection group (10), experienced a lower probability of reflux esophagitis (5.6 vs. 60%) and endoscopic examinations showed a lower severity (Grade B,C,D; 0 vs. 50%). CONCLUSIONS: EG combined with a reflux prevention procedure is simple and less invasive. In cases in which the conservation of AE is possible, less reflux esophagitis is observed and EG is therefore recommended as an appropriate reconstruction method.

Effects of emptying function of remaining stomach on QOL in postgastrectomy patients.

BACKGROUND: Attention has recently focused on decreased quality of life (QOL) that occurs in postgastrectomy patients. We verified how gastric emptying function affected QOL. METHODS: Subjects were 72 consecutive patients after gastrectomy for cancer, including 25 after distal gastrectomy (DG), 18 after proximal gastrectomy (PG), 16 after pylorus-preserving gastrectomy (PpG), and 13 after total gastrectomy (TG). Using the (13)C breath test method, (13)CO(2) levels in breath were measured over 2 h, and T (max) was determined. Questionnaires (Japanese versions of the Short-Form 36 [SF-36] and Gastrointestinal Symptom Rating Scale [GSRS]) were used to analyze QOL and correlations between questionnaire results and T (max). RESULTS: Mean T (max) (min) for each procedure was 15.4 for DG, 21.1 for PG, 41.3 for PpG, and 10.4 for TG. T (max) differed between procedures, but not between survey periods. SF-36 was not correlated with T (max), whereas GSRS showed a difference in diarrhea and total score between procedures, but not between survey periods. In addition, GSRS correlated with T (max) for abdominal pain, indigestion, and total score. The total scores showed a significant symptom aggregation in patients with T (max) less than 21 min. CONCLUSIONS: Gastrointestinal symptoms in postgastrectomy patients were associated with the function of the remaining stomach. The (13)C breath test is useful for objectively assessing such symptoms.

[Roles of positron emission tomography/computed tomography (PET/CT) in the management of colorectal cancer].

In diagnosis and treatment of colorectal cancer, PET/CT has high sensitivity and specificity in comparison to other modalities, and in the near future is expected to play important roles in these areas. However, because of the high cost, PET/CT must be used cost-effectively. In the diagnosis of colorectal cancer with PET/CT, evaluation of cancer growth is possible, but evaluation of tumor invasion is inadequate. In the diagnosis of lymph node metastases, PET/CT provides higher sensitivity of evaluation in distant lymph nodes. The reason for difficulty in proximal lymph node evaluation is due to the close proximity of the main cancer tumor. In the diagnosis of liver metastases, meta-analysis indicates the need for higher sensitivity and specificity compared to CT and MRI. In the diagnosis of pulmonary metastases, chest CT should be obtained in very early pulmonary metastases because of the tiny tumor size in the early stage. In the diagnosis of local recurrence, discrimination between postoperative change and recurrence is difficult, but PET/CT is very useful as a qualitative diagnostic tool. Recent reports have also indicated the usefulness of PET/CT in the evaluation of treatment efficacy in chemotherapy or radiotherapy.

Assessment of lymph node micrometastasis in early gastric cancer in relation to sentinel nodes.

BACKGROUND: The development of endoscopic resection and reduced surgical procedures has progressed in recent years. Lymph node micrometastases can be cited as one of the problems with reduced operations. In this study, we investigated clinicopathological findings and sentinel lymph nodes (SNs) for associations with micrometastases. We discuss the indications for endoscopic mucosal resection (EMR), reduced surgery, and sentinel node navigation surgery (SNNS) based on the results. METHODS: Immunostaining with anti-cytokeratin antibodies was used as the method of exploring for micrometastases. Comparisons and assessments were made in regard to the presence or absence of micrometastases and various clinicopathological factors. RESULTS: The relationship between the clinicopathological factors and micrometastases was investigated in 120 patients with pT1pN0 gastric cancer. Significant differences in depth of invasion (mucosal [m] versus submucosal [sm]) and histological type (differentiated versus undifferentiated) were observed in both univariate analysis and multivariate analysis. Micrometastases were observed in 32% of the sm cancers, and they were observed in group 2 lymph nodes (no. 7) in 8%. They tended to be more common in the undifferentiated type. The micrometastatic lymph nodes were restricted to blue nodes (BNs) and lymph nodes within the dye flow area of patent blue (used intraoperatively explore for SNs). CONCLUSION: It is considered that the indications for current EMR and reduced surgery in early gastric cancer are valid from the standpoint of micrometastases. But if the SNNS that has been studied in recent years is introduced, the lymphatic basin dissection method seems valid only if the case is s-pN0 early cancer.