Feasibility of a standardized pathological protocol for lymphatic basin evaluation during sentinel node navigation surgery in early gastric cancer: preliminary results from the FLECSS trial.
7 affiliations
- 1Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
- 2National Clinical Research Center for Digestive Diseases & National Key Laboratory of Digestive Health, Beijing, China.
- 3Beijing Key Laboratory of Cancer Invasion and Metastasis Research, Beijing, China.
- 4General Surgery Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
- 5Department of Clinical Nutrition, Capital Medical University, Beijing, China.
- 6School of Basic Medical Sciences, Capital Medical University, Beijing, China.
- 7Gastroenterology Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Abstract
During sentinel node navigation surgery (SNNS) in patients with early gastric cancer (EGC), pathologic examination of lymphatic basin specimen is crucial. In this study, we established and evaluated the feasibility and preliminary diagnostic concordance of a standardized pathologic protocol. A retrospective analysis was conducted using data from the Fluorescence guided Laparoscopic-Endoscopic Cooperative Sentinel node navigation surgery Strategy trials (FLECSS) from February 2024 and December 2025. The protocol comprised lymphatic basin specimen collection, processing, and pathological evaluation, intraoperative frozen section analysis, postoperative pathological examination, and the detection of occult metastases. The effectiveness and reliability were evaluated by examining the concordance with postoperative pathology. Lymphatic basins were successfully identified in all 60 patients. Intraoperative evaluation identified 496 nodes (mean 8.3 per patient), of which 67.3% were sentinel nodes (SNs) and 32.7% were non-SNs within the basin. Four patients (6.7%) were diagnosed with lymph node metastasis (LNM) on intraoperative frozen section and were successfully converted to radical gastrectomy with D2 lymphadenectomy. Among these, one patient had additional LNM outside lymphatic basin in the D2 specimen. The protocol demonstrated concordance between intraoperative and postoperative findings in this cohort, with no metastatic involvement detected in non-SNs or occult nodes (ONs) within the basin. This structured pathological protocol appears feasible and showed favorable concordance between intraoperative and postoperative pathological findings in this preliminary cohort. However, its diagnostic performance and oncological reliability require further validation in larger studies with longer follow-up. The detection of micrometastasis and ONs within the basin underscores the potential value of standardized ultra-staging pathology in the pathological assessment of SNNS specimens.
Related
- Adapting Non-Violent Resistance for Families of Young People with Complex Neurodevelopmental Needs: A Service Evaluation of Feasibility, Acceptability, and Preliminary Clinical Outcomes
- A voice-guided real-time artificial intelligence system for navigation and quality control during standardized mediastinal endosonography scanning.
- Near-infrared fluorescent clip-guided navigation in robot-assisted thoracoscopic esophagectomy for esophageal cancer: a single-center feasibility study
- Feasibility, Safety, and Preliminary Efficacy of Partnered Rhythmic Rehabilitation in Prodromal Alzheimer's Disease: A 12-Month Pilot Randomized Controlled Trial
- Smartwatch-based pelvic tracking system for augmented reality navigation in total hip arthroplasty: a preliminary clinical study.
BibTeX
@article{xu2026feasibility,
title = {{Feasibility of a standardized pathological protocol for lymphatic basin evaluation during sentinel node navigation surgery in early gastric cancer: preliminary results from the FLECSS trial.}},
author = {Rui Xu and Zimeng Wang and Zhi Zheng and Danyang Yin and Yueyang Jian and Yu Zhao and Lei Niu and Jie Yin and Xiaoye Liu and Jun Cai and Xiujing Sun and Shengtao Zhu and Guangyong Chen and Peng Li and Jun Zhang and Zhongtao Zhang and Shutian Zhang},
journal = {Journal of gastrointestinal oncology},
year = {2026},
month = aug,
doi = {10.21037/jgo-2026-0602},
url = {https://europepmc.org/article/MED/42996593},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Feasibility of a standardized pathological protocol for lymphatic basin evaluation during sentinel node navigation surgery in early gastric cancer: preliminary results from the FLECSS trial.
AU - Rui Xu
AU - Zimeng Wang
AU - Zhi Zheng
AU - Danyang Yin
AU - Yueyang Jian
AU - Yu Zhao
AU - Lei Niu
AU - Jie Yin
AU - Xiaoye Liu
AU - Jun Cai
AU - Xiujing Sun
AU - Shengtao Zhu
AU - Guangyong Chen
AU - Peng Li
AU - Jun Zhang
AU - Zhongtao Zhang
AU - Shutian Zhang
PY - 2026
DA - 2026/08/10
JO - Journal of gastrointestinal oncology
DO - 10.21037/jgo-2026-0602
UR - https://europepmc.org/article/MED/42996593
AB - During sentinel node navigation surgery (SNNS) in patients with early gastric cancer (EGC), pathologic examination of lymphatic basin specimen is crucial. In this study, we established and evaluated the feasibility and preliminary diagnostic concordance of a standardized pathologic protocol. A retrospective analysis was conducted using data from the Fluorescence guided Laparoscopic-Endoscopic Cooperative Sentinel node navigation surgery Strategy trials (FLECSS) from February 2024 and December 2025. The protocol comprised lymphatic basin specimen collection, processing, and pathological evaluation, intraoperative frozen section analysis, postoperative pathological examination, and the detection of occult metastases. The effectiveness and reliability were evaluated by examining the concordance with postoperative pathology. Lymphatic basins were successfully identified in all 60 patients. Intraoperative evaluation identified 496 nodes (mean 8.3 per patient), of which 67.3% were sentinel nodes (SNs) and 32.7% were non-SNs within the basin. Four patients (6.7%) were diagnosed with lymph node metastasis (LNM) on intraoperative frozen section and were successfully converted to radical gastrectomy with D2 lymphadenectomy. Among these, one patient had additional LNM outside lymphatic basin in the D2 specimen. The protocol demonstrated concordance between intraoperative and postoperative findings in this cohort, with no metastatic involvement detected in non-SNs or occult nodes (ONs) within the basin. This structured pathological protocol appears feasible and showed favorable concordance between intraoperative and postoperative pathological findings in this preliminary cohort. However, its diagnostic performance and oncological reliability require further validation in larger studies with longer follow-up. The detection of micrometastasis and ONs within the basin underscores the potential value of standardized ultra-staging pathology in the pathological assessment of SNNS specimens.
SN - 2078-6891
SN - 2219-679X
ER -