Sentinel Lymph Node Mapping in Colon and Rectal Cancer
Sentinel lymph node (SLN) mapping has been widely applied in the staging of solid neoplasms including colon and rectal cancer. Since the first reported feasibility study in 1997, there have been numerous publications validating SLN mapping as a highly accurate and powerful upstaging technique for colon and rectal cancer. In addition to refining the technical aspects of this procedure, these studies have investigated the use of other tracers and operative techniques, while determining the indications, limitations, and pitfalls of SLN mapping in patients with colorectal cancers. This chapter reviews the rationale for performing SLN mapping for the accurate staging of colon and rectal cancers, and provides a brief review of the historical background of the development of the procedure. Landmark publications, which have contributed to the current status of the technique, are discussed. We will focus on the technical details of the procedure, and on the pathological evaluation of the specimen and the SLNs. The various tracers and techniques of SLN mapping in colon and rectal cancer will be discussed. We have performed SLN mapping in more than 240 consecutive patients over the past 7 years. The success rates for identifying at least one SLN for colon and rectal cancer were 100% and 90.6%, respectively. The accuracy rates were 95.8% and 100%, respectively. In terms of upstaging, 32.3% of colon cancer patients with nodal metastases and 16.7% of rectal patients with nodal metastases were upstaged by the detection of micrometastases found in the SLNs only. Finally, we will also discuss the current role as well as the future research directions for SLN mapping in colon and rectal cancer.
KeywordsRectal Cancer Sentinel Lymph Node Lymphatic Mapping Sentinel Lymph Node Mapping AJCC Stage
Unable to display preview. Download preview PDF.
- 2.Bilchik A, Giuliano A, Essner R, et al. Universal application of intraoperative lymphatic mapping and sentinel lymphadenectomy in solid neoplasms. Cancer J 1998;4(6): 351–358.Google Scholar
- 3.Bilchik A, Saha S, Tsioulias G, et al. Aberrant drainage of missed micrometastases: The value of lymphatic mapping and focused analysis of sentinel lymph nodes in gastrointestinal neoplasms. Ann Surg Oncol 2001;8(9S):82–85.Google Scholar
- 9.Dan A, Saha S, Wiese D, et al. Comparative analysis of Lymphazurin 1% vs. fluorescein 10% in sentinel lymph node (SLN) mapping for colorectal (CR) tumors. Archi Surg 2004 (in press)Google Scholar
- 27.Longnecker SM, Guzzardo MM, Van Voris LP. Life-threatening anaphylaxis following subcutaneous administration of isosulfan blue 1%. Clin Pharmacol 1985; 4(2): 219–221.Google Scholar
- 29.Morton DL, Wen DR, Wong HH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Archi Surg 1992;127(4):392–399.Google Scholar
- 35.Saha S, Ganatra BK, Gauthier J, et al. Localization of sentinel lymph node in colon cancer. A feasibility study. Society of Surgical Oncology 50th Annual Cancer Symposium. 1997, Chicago, IL. Abstract P-80, page 54.Google Scholar
- 37.Saha S, Bilchik A, Wiese D, et al. Ultrastaging of colorectal cancer by sentinel lymph node mapping technique–A multicenter trial. Ann Surg Oncol 2001;8(9S):94–98.Google Scholar
- 38.Saha S, Dan A, Berman B, et al. Lymphazurin 1% vs. TSC for lymphatic mapping in colorectal tumors — A comparative analysis. Ann Surg Oncol 2004; 11(1): in press.Google Scholar
- 42.Viehl CT, Hamel CT, Marti WR, et al. Identification of sentinel lymph nodes in colon cancer depends on the amount of dye injected relative to tumour size. World J Surg 2003; 27(12): in print.Google Scholar
- 47.Wood T, Saha S, Morton D, et al. Validation of lymphatic mapping in colorectal cancer: In vivo, ex vivo, and laparoscopic techniques. Dis Colon Rectum 2001;8(2):150–157.Google Scholar