Annals of Surgical Oncology

, Volume 19, Issue 11, pp 3449–3459 | Cite as

Systematic Review of Sentinel Lymph Node Mapping Procedure in Colorectal Cancer

  • Edwin S. van der ZaagEmail author
  • Wim H. Bouma
  • Pieter J. Tanis
  • Dirk T. Ubbink
  • Willem A. Bemelman
  • Christianne J. Buskens
Colorectal Cancer



The clinical impact of sentinel lymph node (SN) biopsy in colorectal cancer is still controversial. The aim of our study was to determine the accuracy of this procedure from published data and to identify factors that contribute to the conflicting reports.


A systematic search of the Medline, Embase, and Cochrane databases up to July 2011 revealed 98 potentially eligible studies, of which 57 were analyzed including 3,934 patients (3,944 specimens).


The pooled SN identification rate was 90.7 % (95 % CI 88.2–93.3), with a significant higher identification rate in studies including more than 100 patients or studies using the ex vivo SN technique. The pooled sensitivity of the SN procedure was 69.6 % (95 % CI 64.7–74.6). Including the immunohistochemical findings increased the pooled sensitivity of SN procedure to 80.2 % (95 % CI 4.7–10.7). Subgroups with significantly higher sensitivity could be identified: ≥4 SNs versus <4 SNs (85.2 vs. 66.3 %, p = 0.003), colon versus rectal cancer (77.6 vs. 65.7 %, p = 0.04), early T1 or T2 versus advanced T3 or T4 carcinomas (93.4 vs. 58.8 %, p = 0.01). Serial sectioning and immunohistochemistry resulted in a mean upstaging of 18.9 % (range 0–50 %). True upstaging defined as micrometastases (pN1mi+) rather than isolated tumor cells (pN0itc+) was 7.7 %.


The SN procedure in colorectal cancer has an overall sensitivity of 70 %, with increased sensitivity and refined staging in early-stage colon cancer. Because the ex vivo SN mapping is an easy technique it should be considered in addition to conventional resection in colon cancer.


Rectal Cancer Sentinel Lymph Node Sentinel Lymph Node Biopsy Lymphatic Mapping Isolate Tumor Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

There are no financial interests or conflicts of interests to disclose in the subject of this study.


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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Edwin S. van der Zaag
    • 1
    Email author
  • Wim H. Bouma
    • 1
  • Pieter J. Tanis
    • 2
  • Dirk T. Ubbink
    • 3
  • Willem A. Bemelman
    • 2
  • Christianne J. Buskens
    • 2
  1. 1.Department of SurgeryGelre ZiekenhuizenApeldoornThe Netherlands
  2. 2.Department of SurgeryAcademic Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Quality Assurance & Process InnovationAcademic Medical CenterAmsterdamThe Netherlands

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