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A Prospective Study of False-Positive Diagnosis of Micrometastatic Cells in the Sentinel Lymph Nodes in Colorectal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Sentinel lymph node mapping (SLNM) with multilevel sections (MLS) and cytokeratin immunohistochemistry (CK-IHC) of sentinel lymph nodes (SLNs) upstages 15–20% of patients (pts). False-positive SLNs occur in breast cancer due to mechanical transport of cells during mapping procedures, or to pre-existing benign cellular inclusions. Our prospective study evaluated whether colorectal mapping procedures alone caused false positives.

Methods

A total of 314 pts underwent SLNM with blue dye. Ninety of the pts underwent a second mapping in normal bowel away from the primary tumor. The first 1–5 blue nodes near the primary tumor were marked as SLNs; those near the second injection site were marked as nontumor SLNs (nt-SLNs). All SLNs and nt-SLNs were evaluated by MLS and CK-IHC.

Results

Of 314 pts, 30 had benign tumor and 284 had invasive cancer. SLNM was successful in 274/284 (96.5%) invasive cancer pts, with 728 SLNs identified. Forty-six of the 274 pts (16.8%) had low-volume metastasis in 57 SLNs: 31 pts (11.3%) had 38 SLNs with micrometastasis (>0.2 mm, ≤2 mm), while 15 pts (5.5%) had 19 SLNs with isolated tumor cells (≤0.2 mm). For 100 pts with second SLNM (70/90 pts successfully mapped with 102 nt-SLNs), or with SLNM of benign pathology (30/30 pts successfully mapped with 88 SLNs), there were no false positives in any of 190 nodes (P < 0.001).

Conclusion

No false positives due to mechanical transport of cells or to benign cellular inclusions were identified in 190 lymph nodes from 100 patients with SLNM in benign bowel.

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Acknowledgment

The authors thank Drs. Julio Badin, Peter Ng, Nader Bassily, Weimin Liu, Ernesto Quiachon, and Aamir Ahsan for their participation in the pathologic evaluation of the cases.

DISCLOSURES

No commercial or other disclosures are reported by the authors of this study.

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Authors and Affiliations

  1. Department of Pathology, Michigan State University, McLaren Regional Medical Center, Flint, MI, USA

    D. Wiese MD, PhD & B. Yestrepsky BA

  2. Department of Surgery, Michigan State University, McLaren Regional Medical Center, Flint, MI, USA

    S. Saha MD, A. Korant MD & S. Sirop MD

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  1. D. Wiese MD, PhD
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  2. S. Saha MD
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  3. B. Yestrepsky BA
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  4. A. Korant MD
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  5. S. Sirop MD
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Corresponding author

Correspondence to D. Wiese MD, PhD.

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Wiese, D., Saha, S., Yestrepsky, B. et al. A Prospective Study of False-Positive Diagnosis of Micrometastatic Cells in the Sentinel Lymph Nodes in Colorectal Cancer. Ann Surg Oncol 16, 2166–2169 (2009). https://doi.org/10.1245/s10434-009-0497-2

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  • DOI: https://doi.org/10.1245/s10434-009-0497-2

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