***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract The clinical application of sentinel node biopsies in early gastric cancer is still controversial even though it appears promising . This study was conducted as a prerequisite quality control for surgical st and ardization of laparoscopic sentinel basin dissection ( SBD ) prior to the initiation of a phase III trial . Laparoscopic SBD was performed in patients with preoperative stage T1 - 2N0 and tumor size < 4 cm in diameter .  Intraoperative endoscopic submucosal injection of a st and ardized dual tracer was administered . All retrieved sentinel basin nodes ( SBN ) were investigated with intraoperative frozen hematoxylin and eosin  ( H&E ) staining . A strict checklist consisting of 7 essential steps was followed during laparoscopic SBD as the quality control study for a phase III trial . Completion of all essential steps in the checklist for 10 cases was used to define a qualified institution . Seven institutions participated and 112 patients were enrolled in this study . However , 4 patients were excluded owing to screening failure . The mean number of cases required for institutional qualification was 15 cases ( range , 13–20 cases ) . Sentinel basins ( SB ) were detected and dissected in 100 of the 108 patients ( 92.6 % ) ; the median number of SB and SBN was 2 and 7 , respectively . Lymph node metastases were detected in 10 patients by postoperative permanent H&E staining and they were detected by SBD in all 10 patients . Frozen results of SBN were compatible with permanent staining reports . Laparoscopic SBD is feasible and demonstrated improved sensitivity in detecting metastatic lymph nodes compared to the previous study . A future phase III r and omized trial comparing laparoscopic SBD with organ-preserving gastrectomy and laparoscopic st and ard gastrectomy seems promising for qualified institutions AIM To investigate feasibility and accuracy of near-infrared fluorescence imaging using indocyanine green : nanocolloid for sentinel lymph node ( SLN ) detection in gastric cancer . METHODS A prospect i ve , single-institution , phase I feasibility trial was conducted . Patients suffering from gastric cancer and planned for gastrectomy were included . During surgery , a subserosal injection of 1.6 mL ICG : Nanocoll was administered around the tumor . NIR fluorescence imaging of the abdominal cavity was performed using the Mini-FLARE ™ NIR fluorescence imaging system . Lymphatic pathways and SLNs were visualized . Of every detected SLN , the corresponding lymph node station , signal-to- background ratio and histopathological diagnosis was determined . Patients underwent st and ard-of-care gastrectomy . Detected SLNs outside the st and ard dissection planes were also resected and evaluated . RESULTS Twenty-six patients were enrolled . Four patients were excluded because distant metastases were found during surgery or due to technical failure of the injection . In 21 of the remaining 22 patients , at least 1 SLN was detected by NIR Fluorescence imaging ( mean 3.1 SLNs ; range 1 - 6 ) . In 8 of the 21 patients , tumor-positive LNs were found . Overall accuracy of the technique was 90 % ( 70%-99 % ; 95%CI ) , which decreased by higher pT-stage ( 100 % , 100 % , 100 % , 90 % , 0 % for respectively Tx , T1 , T2 , T3 , T4 tumors ) . All NIR-negative SLNs were completely effaced by tumor . Mean fluorescence signal-to- background ratio of SLNs was 4.4 ( range 1.4 - 19.8 ) . In 8 of the 21 patients , SLNs outside the st and ard resection plane were identified , that contained malignant cells in 2 patients . CONCLUSION This study shows successful use of ICG : Nanocoll as lymphatic tracer for SLN detection in gastric cancer . Moreover , tumor-containing LNs outside the st and ard dissection planes were identified Background Prospect i ve multicenter trials have shown the feasibility of sentinel node ( SN ) navigation surgery using a dual tracer of dye and radioisotope for early gastric cancer . However , comparable trials using the indocyanine green ( ICG ) and the infrared ray laparoscopic system ( IRLS ) have not been reported . On the basis of our cohort studies , we assumed that the ICG imaging with the IRLS is as effective as the dual tracer in detecting SNs . Therefore , we conducted a prospect i ve multicenter trial to assess the effectiveness and generalizability of the infrared ICG technique in patients with early gastric cancer . Patients and methods Patients with previously untreated cT1 gastric adenocarcinomas less than 4 cm in gross diameter were eligible for inclusion in this study . SN mapping was performed by using ICG combined with IRLS technique . Following biopsy of the identified SNs , D2 or modified D2 laparoscopic gastrectomy was performed according to the current Japanese Gastric Cancer Association guidelines . Results Among the 47 patients who gave written informed consent , 44 were eligible from the surgical findings , for whom SN biopsy was performed . The detection rate of the lymphatic basin by the ICG with IRLS was 100 % ( 44/44 ) . The accuracy was also 100 % ( 7/7 ) for detecting metastatic lymph node , which was verified on the permanent pathologic examination . Following the median follow-up of 114 months ( range , 60 to 120 months ) , no recurrence ( 0/40 ) was observed . Although the number of patients was unequally distributed among the hospitals participating in the trial , the detection rates of SNs in low-volume hospitals were comparable to those in high-volume hospitals . Consequently , there was no learning curve in this trial . Conclusion The infrared ICG imaging accurately detected the lymphatic basin and SNs with occult metastasis in SN-navigated gastrectomy for gastric cancer . This method was feasible even for low-volume surgeons and hospitals More than ten years have passed since the sentinel node ( SN ) concept for gastric cancer surgery was first discussed . Less invasive modified surgical approaches based on the SN concept have already been put into practice for malignant melanoma and breast cancer , however the SN concept is not yet placed in a st and ard position in gastric cancer surgery even after two multi-institutional prospect i ve clinical trials , the Japan Clinical Oncology Group trial ( JCOG0302 ) and the Japanese Society for Sentinel Node Navigation Surgery ( SNNS ) trial . What is the problem in the clinical application of the SN concept to gastric cancer surgery ? There is no doubt that we need reliable indicator(s ) to determine with certainty the absence of metastasis in the lymph nodes in order to avoid unnecessary lymphadenectomy . There are several matters of debate in performing the actual procedure , such as the type of tracer , the site of injection , how to detect and harvest , how to detect metastases of SNs , and learning period . These issues have to be addressed further to establish the most suitable procedure . Novel technologies such as indocyanine green ( ICG ) fluorescence imaging and one-step nucleic acid amplification ( OSNA ) may overcome the current difficulties . Once we know what the problems are and how to tackle them , we can pursue the goal Background Along with the marked increase in early gastric cancer ( EGC ) in the Eastern countries , there has been an effort to adopt the sentinel node concept in EGC to preserve gastric function and reduce the occurrence of postoperative complications . Based on promising results from a previous quality control study , this prospect i ve multicenter r and omized controlled phase III clinical trial aims to eluci date the oncologic safety of laparoscopic stomach-preserving surgery with sentinel basin dissection ( SBD ) compared to a st and ard laparoscopic gastrectomy . Methods / Design This trial is an investigator-initiated , open-label , multicenter r and omized controlled phase III trial with a non-inferiority design . Patients diagnosed with a single lesion of clinical stage T1N0M0 gastric adenocarcinoma , with a diameter of 3 cm or less are eligible for the present study . A total of 580 patients ( 290 per group ) will be r and omized to either laparoscopic stomach-preserving surgery with SBD or st and ard surgery . The primary end-point is 3-year disease-free survival ( DFS ) and the secondary endpoints include postoperative morbidity and mortality , quality of life , 5-year DFS , and overall survival . Qualified investigators who completed the prior quality control study are exclusively allowed to participate in this phase III clinical trial . Discussion The proposed trial is expected to verify whether laparoscopic stomach-preserving surgery with SBD achieves similar oncologic outcomes and improved quality of life compared to a st and ard gastrectomy in EGC patients .Trial registration This study was registered at the NIH Clinical Trial.gov data base ( NCT01804998 ) on March 4th , 2013 BACKGROUND Examination of at least 16 lymph nodes ( LNs ) has been traditionally recommended during gastric adenocarcinoma resection to optimize staging , but the impact of this strategy on survival is uncertain . Because recent r and omized trials have demonstrated a therapeutic benefit from extended lymphadenectomy , we sought to investigate the impact of the number of LNs removed on prognosis after gastric adenocarcinoma resection . STUDY DESIGN We analyzed patients who underwent gastrectomy for gastric adenocarcinoma from 2000 to 2012 , at 7 US academic institutions . Patients with M1 disease or R2 resections were excluded . Disease-specific survival ( DSS ) was calculated using the Kaplan-Meier method and compared using log-rank and Cox regression analyses . RESULTS Of 742 patients , 257 ( 35 % ) had 7 to 15 LNs removed and 485 ( 65 % ) had ≥16 LNs removed . Disease-specific survival was not significantly longer after removal of ≥16 vs 7 to 15 LNs ( 10-year survival , 55 % vs 47 % , respectively ; p = 0.53 ) for the entire cohort , but was significantly improved in the subset of patients with stage IA to IIIA ( 10-year survival , 74 % vs 57 % , respectively ; p = 0.018 ) or N0 - 2 disease ( 72 % vs 55 % , respectively ; p = 0.023 ) . Similarly , for patients who were classified to more likely be " true N0 - 2 , " based on frequentist analysis incorporating both the number of positive and of total LNs removed , the hazard ratio for disease-related death ( adjusted for T stage , R status , grade , receipt of neoadjuvant and adjuvant therapy , and institution ) significantly decreased as the number of LNs removed increased . CONCLUSIONS The number of LNs removed during gastrectomy for adenocarcinoma appears itself to have prognostic implication s for long-term survival BACKGROUND The survival benefit and morbidity after nodal dissection for gastric cancer remains controversial . We aim ed to do a single-institution r and omised trial to compare D1 ( ie , level 1 ) lymphadenectomy with that of D3 ( ie , levels 1 , 2 , and 3 ) dissection for gastric cancer in terms of overall survival and disease-free survival . METHODS From Oct 7 , 1993 , to Aug 12 , 1999 , 335 patients were registered . 221 patients were eligible , 110 of whom were r and omly assigned D1 surgery and 111 of whom were r and omly assigned D3 surgery , both with curative intent . Three participating surgeons had done at least 25 independent D3 dissections before the start of the trial , and every procedure was verified by pathological analyses . The primary endpoints were 5-year overall survival and 5-year disease-free survival . We also analysed risk of recurrence . Main analyses were done by intention to treat . This trial is registered at the US National Institute of Health website . FINDINGS Median follow-up for the 110 ( 50 % ) survivors was 94.5 months ( range 62.9 - 135.1 ) . Overall 5-year survival was significantly higher in patients assigned D3 surgery than in those assigned D1 surgery ( 59.5 % [ 95 % CI 50.3 - 68.7 ] vs 53.6 % [ 44.2 - 63.0 ] ; difference beteween groups 5.9 % [ -7.3 to 19.1 ] , log-rank p=0.041 ) . 215 patients who had R0 resection ( ie , no microscopic evidence of residual disease ) had recurrence at 5 years of 50.6 % [ 41.1 - 60.2 ] for D1 surgery and 40.3 % [ 30.9 - 49.7 ] for D3 surgery ( difference between groups 10.3 % [ -3.2 to 23.7 ] , log-rank p=0.197 ) . INTERPRETATION D3 nodal dissection , compared with that of D1 , offers a survival benefit for patients with gastric cancer when done by well trained , experienced surgeons BACKGROUND Historical data and recent studies show that st and ardised extended ( D2 ) lymphadenectomy leads to 
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IREE had improved diagnostic odds ratio , sensitivity , and identification rate compared to NIFI .
Conclusions We found encouraging results regarding the accuracy , diagnostic odds ratio , and specificity of the test .
The sensitivity was not optimal but may be improved by a strict protocol to augment the technique .