Lymphatic Drainage Routes of the Gastric Cardia Visualized by Lymphoscintigraphy

This study was undertaken to assess the feasibility of lympho-scintigraphy of the gastric cardia and to identify the incidence of paraesophageal lymphatic drainage, precluding total gastrec-tomy with esophagojejunostomy as a potentially curative ther-apy for gastric cardia cancer. Methods: Ten patients scheduled for esophagectomy with high-grade dysplasia or with esopha-geal cancer at least 3 cm above the esophagogastric junction were enrolled in this study. Preoperatively, 111 MBq of 99mTc-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. Lo-coregional lymph node stations were measured for radioactivity by a -probe intraoperatively and ex vivo in the resection spec-imen. Results: In each patient, at least 1 radioactive lymph node station was detected. In total, 42 radioactive lymph node sta-tions were detected by -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 feasi-ble and can accurately determine the location of radioactive lymph nodes. Early paraesophageal lymphatic drainage is rare. Key Words: lymphoscintigraphy; lymph flow; gastric cardia car-cinoma; esophagu