Technical Details of Sentinel Lymph Node Mapping in Colorectal Cancer and Its Impact on Staging
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Background: Sentinel lymph node (SLN) mapping for melanoma and breast cancer has greatly enhanced the identification of micrometastases in many patients, thereby upstaging a subset of these patients. The purpose of this study was to see if SLN mapping technique could be used to identify SLNs in colorectal cancer and to assess its impact on pathological staging and treatment.
Methods: At the time of surgery, 1 ml of Lymphazurin 1% was injected subserosally around the tumor without injecting into the lumen. The first to fourth blue nodes identified were considered the SLNs, which have the highest probability to contain metastases. A standard oncological resection of the bowel was then performed. Multilevel microsections of the SLNs, including a detailed pathological examination of the entire specimen, was performed.
Results: SLN was successfully identified in 85 (98.8%) of 86 patients. In 85 patients, there were 1367 (16 per patient) lymph nodes examined, of which 140 (1.6 per patient) were identified as SLNs. In 53 (95%) of 56, of whom the SLNs were without metastases (negative), all other non-SLNs also were negative. In 29 (34% of 85) patients, SLNs were positive for metastases; in 14 of the 29 patients, other non-SLNs also were positive in addition to the SLNs. In the other 15 of the 29 patients (18% of 85 patients), SLNs were the only site of metastases, and all other non-SLNs were negative. In 7 patients (8.2% of 85 patients), micrometastases were identified only in 1 or 2 of the 10 sections of a single SLN. In five of seven patients, such micrometastases were detected by hematoxylin and eosin staining and immunohistochemistry; in the other two patients, it was detected only by immunohistochemistry. In patients with negative SLNs, the rate of occurrence of micrometastases in non-SLNs was 5 (0.4%) of 1184 lymph nodes.
Conclusions: SLN mapping can be performed easily in colorectal cancer patients, with an accuracy of more than 95%. The identification of submicroscopic lymph node metastases by this technique may have upstaged these patients (18%) from stage I/II to stage III disease, who may then benefit from further adjuvant chemotherapy.
- Landis, SH, Murray, T, Bolden, S, Wingo, P (1998) Cancer statistics 1998. CA Cancer J Clin 48: pp. 12-14 CrossRef
- Cohen, AM, Kelsen, D, Saltz, L (1998) Adjuvant therapy for colorectal cancer. Curr Prob Cancer 22: pp. 5-65
- Gusterson, B (1992) Are micrometastases clinically relevant?. Br J Hosp Med 47: pp. 247-248
- Broll, R, Schauer, V, Schimmelpenning, H, Strik, M, Woltmann, AL, Best, R (1997) Prognostic relevance of occult tumor cells in lymph nodes of colorectal carcinomas. Dis Colon Rectum 40: pp. 1465-1471
- Greenson, J, Isenhard, C, Rice, R, Mojzisk, C, Houchens, D, Martin, E (1994) Identification of occult micro metastases in pericolic lymph nodes of Dukes’ B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49. Cancer 73: pp. 563-569
- Herrera-Omelas, L, Justiniano, J, Castillo, N (1987) Metastasis in small lymph nodes from colon cancer. Arch Surg 122: pp. 1253-1256
- Morton, D, Wen, D, Wong, J (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127: pp. 392-399
- Krag, DN, Weaver, DI, Alex, JC, Fairbank, JT (1993) Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 2: pp. 335-339 CrossRef
- Giuliano, A, Jones, R, Brennan, M, Statman, R (1997) Sentinel lymphadenectomy in breast cancer. J Clin Oncol 15: pp. 2345-2350
- Albertini, J, Lyman, G, Cox, C (1996) Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 276: pp. 1818-1822 CrossRef
- Technical Details of Sentinel Lymph Node Mapping in Colorectal Cancer and Its Impact on Staging
Annals of Surgical Oncology
Volume 7, Issue 2 , pp 120-124
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- Sentinel lymph node mapping
- Colorectal cancer
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- 1. Departments of Anatomy, Michigan State University, McLaren Regional Medical Center, 3500 Calkins Rd, Suite A, Flint, MI, 48532
- 2. Departments of Surgery, Michigan State University, McLaren Regional Medical Center, 3500 Calkins Rd, Suite A, Flint, MI, 48532
- 3. Departments of Pathology, McLaren Regional Cancer Center, 3500 Calkins Rd, Suite A, Flint, MI, 48532
- 4. Departments of Gastroenterology, McLaren Regional Cancer Center, 3500 Calkins Rd, Suite A, Flint, MI, 48532
- 5. Departments of Medical Oncology, McLaren Regional Cancer Center, 3500 Calkins Rd, Suite A, Flint, MI, 48532