SENTINEL LYMPH NODES IN HUMAN SOLID CANCER zyxwvu 0039-6109/00 $15.00 + z .OO THE ROLE OF THE SENTINEL LYMPH NODE IN GASTROINTESTINAL CANCER Yuko Kitagawa, MD, Hirofumi Fujii, MD, Makio Mukai, MD, Tetsuro Kubota, MD, Nobutoshi Ando, MD, Masahiko Watanabe, MD, Masahiro Ohgami, MD, Yoshihide Otani, MD, Soji Ozawa, MD, Hirotoshi Hasegawa, MD, Toshiharu Furukawa, MD, Koichiro Kumai, MD, Tadashi Ikeda, MD, Tadaki Nakahara, MD, Atsushi Kubo, MD, and Masaki Kitajima, MD The sentinel node concept has been validated in the fields of breast cancer and malignant melanoma.', 6, zyxwvutsrq '2 zyxwv 14, l7 To date, application of the sentinel lymphade- nectomy is considered to be one of the most important modalities for the multidisciplinary management of breast cancer and melanoma. The accuracy of prediction of nodal status by sentinel node navigation, in recent studies for breast cancer, is more than 95%.2* l6 The feasibility and diagnostic reliability of sentinel node mapping of gastrointestinal (GI) cancers, however, are still unclear and controversial. There are several reasons why the sentinel node concept has not been well studied in GI cancers. It has been thought that nodal metastases occur in a random process and that second and third compartments of regional lymph nodes are likely to be involved in metastatic disease without involvement of nodes closest to the primary lesion of GI cancers. Generally, GI surgeons are skeptical about the application of the sentinel node concept for GI cancers because of the high incidence of skip metastases." It should be emphasized that so called "skip metastasis" has been defined according to the anatomic classification of regional lymph nodes and that the lymphatic drainage route must be patient-specific or lesion-specific. Therefore the investigation of the From the Departments of Surgery (YK, TK, NA, MW, MO, YO, SO, HH, TF, KK, TI, MK), Radiology (HF, TN, AK), and Pathology (MM), Keio University School of Medicine, Tokyo, Japan ~~ ~ ~ SURGICAL CLINICS OF NORTH AMERICA VOLUME 80 * NUMBER 6 * DECEMBER 2000 1799