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Sentinel Lymph Node Mapping with Isosulfan Blue or Indocyanine Green in Colon Cancer Shows Comparable Results and Identifies Patients with Decreased Survival: A Prospective Single-Center Trial

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Abstract

Background

Sentinel lymph node (SLN) mapping was reported to improve lymph node staging in colon cancer. This study compares isosulfan blue (IB) with indocyanine green (ICG)-based SLN-mapping and assesses the prognostic value of isolated tumor cells (ITC) and micro-metastases in upstaged patients.

Methods

A total of 220 stage I–III colon cancer patients were included in this prospective single-center study. In 170 patients, SLN-mapping was performed in vivo with IB and in 50 patients ex vivo with ICG. Three levels of each SLN were stained with H&E. If negative for tumor infiltration, immunostaining for cytokeratin (AE1/3; cytokeratin-19) was performed.

Results

SLN detection rate for IB and ICG was 100 and 98%, respectively. Accuracy and sensitivity was 88 and 75% for IB, 82 and 64% for ICG, respectively (p = 0.244). Overall, 149 (68%) patients were node negative. In these patients, ITC and micro-metastases were detected in 26% (31/129) with IB and 17% (5/29) with ICG (p = 0.469). Patients with ITC and micro-metastases did show decreased overall survival (hazard ratio = 1.96, p = 0.09) compared to node negative disease.

Conclusions

This study demonstrates a high diagnostic accuracy for both the IB and the ICG SLN-mapping. SLN-mapping upstaged a quarter of patients with node negative colon cancer, and the detected ITC and micro-metastases were an independent negative prognostic marker in multivariate analysis.

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Acknowledgements

We thank Prof. John V. Frangioni (Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts) for his critical comments on this manuscript and the development and allocation of the Mini-Fluorescence-Assisted Resection and Exploration (Mini-FLARE™) near-infrared detection system.

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  1. Benjamin Weixler and Andreas Rickenbacher contributed equally as first authors.

Authors and Affiliations

  1. Department of Surgery, University Hospital Basel, Basel, Switzerland

    Benjamin Weixler

  2. Department of Surgery, Kantonsspital Olten, 4600, Olten, Switzerland

    Benjamin Weixler, Andreas Rickenbacher, Dimitri Aristotle Raptis, Jessica Rueff & Markus Zuber

  3. Department of Visceral Surgery, University Hospital Zürich, Zurich, Switzerland

    Andreas Rickenbacher & Dimitri Aristotle Raptis

  4. Department of Surgery, Hospital Center Biel, Biel/Bienne, Switzerland

    Carsten T. Viehl

  5. Division of Oncology/Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Ulrich Guller

  6. University Clinic for Visceral Surgery and Medicine, Inselspital Berne, University of Berne, Berne, Switzerland

    Ulrich Guller

  7. Viollier AG, Histopathology/Cytology, Basel, Switzerland

    Andreas Zettl

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  1. Benjamin Weixler
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Weixler, B., Rickenbacher, A., Raptis, D.A. et al. Sentinel Lymph Node Mapping with Isosulfan Blue or Indocyanine Green in Colon Cancer Shows Comparable Results and Identifies Patients with Decreased Survival: A Prospective Single-Center Trial. World J Surg 41, 2378–2386 (2017). https://doi.org/10.1007/s00268-017-4051-2

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