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Radioguided Sentinel Lymph Node Mapping and Biopsy in Colorectal Cancer

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Radioguided Surgery

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Abstract

Colorectal cancer is the most frequent malignancy of the gastrointestinal tract. After distant metastasis, the presence of metastases in regional lymph nodes is the main prognostic factor. Examination of only a selected group of lymph nodes harvested separately during the surgical procedure and containing the highest probability of metastatic cells – the sentinel lymph nodes (SLNs) – could be useful in this context given that SLN biopsy allows a more comprehensive analysis of the status of the regional lymph nodes. In this context, it is to be noted that standard H&E histopathology analysis can potentially underestimate the degree of lymph node involvement by failing to recognize micrometastatic disease that may be apparent only at H&E histopathology analysis of serial sections and/or immunohistochemistry. To date, in colorectal cancer, the SLN procedure has only diagnostic relevance. En bloc resection of the tumor and regional lymph node dissection remains the standard treatment.

The most commonly used tracers in lymphatic mapping in colon cancer are colorimetric dyes. The in vivo use of colorimetric dyes does not require any additional technology, does not prolong the procedure significantly, and shows several advantages over the use of a radioisotope. The in vivo administration of dye allows the detection of aberrant lymphatic drainage of the regional lymph nodes. Because of the principle of oncological radicality associated with total mesorectal excision, lymphatic mapping in rectal cancer is frequently done on the specimen ex vivo. Accordingly, there is no impact on intraoperative strategy. In anal cancer (for which radiochemotherapy is the treatment of choice), in selected cases, SLN biopsy has been indicated as a tool for precise and minimally invasive assessment of the regional inguinal lymphatic system and also for further therapeutic decision making (regarding the use of radiotherapy).

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Authors and Affiliations

  1. 1st Department of Surgical Oncology and General Surgery, Greater Poland Cancer Center, ul. Garbary 15, Poznan, 61-866, Poland

    Dawid Murawa & Piotr Nowaczyk

  2. Regional Specialist Hospital in Wroclaw, Research and Development Centre, ul. Kamieńskiego 73a, Wrocław, 51-124, Poland

    Dawid Murawa

  3. Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, Wuerzburg, 97080, Germany

    Armin Wiegering

  4. Department of Biochemistry and Molecular Biology, Theodor-Boveri-Institute, Biocenter, University of Wuerzburg, Wuerzburg, 97070, Germany

    Armin Wiegering

Authors
  1. Dawid Murawa
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  2. Piotr Nowaczyk
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  3. Armin Wiegering
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Correspondence to Dawid Murawa .

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Editors and Affiliations

  1. Universitätsklinikum Würzburg, Department of Nuclear Medicine, Würzburg, Germany

    Ken Herrmann

  2. The University of Sydney, Melanoma Institute Australia, North Sydney, New South Wales, Australia

    Omgo E. Nieweg

  3. Arthur G. James Canc Hosp Richard J. Sol, The Ohio State Univ Comp Canc CTR, Columbus, Ohio, USA

    Stephen P. Povoski

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Murawa, D., Nowaczyk, P., Wiegering, A. (2016). Radioguided Sentinel Lymph Node Mapping and Biopsy in Colorectal Cancer. In: Herrmann, K., Nieweg, O., Povoski, S. (eds) Radioguided Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-26051-8_18

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  • DOI: https://doi.org/10.1007/978-3-319-26051-8_18

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  • Online ISBN: 978-3-319-26051-8

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