Value of staging squamous cell carcinoma of the anal margin and canal using the sentinel lymph node procedure: an update of the series and a review of the literature

Abstract

Background:Inguinal metastases in patients affected by anal cancer are an independent prognostic factor for local failure and overall mortality. Since 2001, sentinel lymph node biopsy was applied in these patients. This original study reports an update of personal and previous published series, which were compared with Literature to value the incidence of inguinal metastases T-stage related and the overall incidence of false negative inguinal metastases at sentinel node.Methods:In all, 63 patients diagnosed with anal cancer submitted to inguinal sentinel node. Furthermore a research in the Pub Med database was performed to find papers regarding this technique.Results:In our series, detection rate was 98.4%. Inguinal metastases were evidentiated in 13 patients (20.6%). Our median follow-up was 35 months. In our series, no false negative nodes were observed.Conclusion:Sentinel node technique in the detection of inguinal metastases in patients affected by anal cancer should be considered as a standard of care. It is indicated for all T stages in order to select patients to be submitted to inguinal radiotherapy, avoiding related morbidity in negative ones. An overall 3.7% rate of false negative must be considered acceptable.

Intensity-Modulated Radiation Therapy with Simultaneous Integrated Boost Combined with Concurrent Chemotherapy for the Treatment of Anal Cancer Patients: 4-Year Results of a Consecutive Case Series

“…Treatment breaks occurred in 41.5% of patients, with a median duration time of 4 days (9). Kachnic et al employed a dose-painted IMRT approach, observing on a retrospective multi-institutional framework, a G3 acute toxicity rate of 7% for GI, 5% for GU, 5% for dermatologic, and 49% for hematologic toxicities (13). In this series, G4 events were observed not only for hematologic toxicity (12%), but also for GU (2%) and dermatologic (5%).…”

“…The clinical evaluation included complete medical history with physical examination, comprising a digital rectal examination and complete laboratory testing. Disease staging included a chest, abdomen, and pelvis computed tomography scan (CT), a magnetic resonance imaging (MRI) of the pelvic region, positron-emission tomography (PET) and/or inguinal sentinel lymphnode biopsy (SLNB), and eventual endoscopic transrectal ultrasounds (EUS) (12,13).…”

Anal Carcinoma: A Series of Cases with a Literature Review

“…Lymph node involvement in diagnosis is observed in 30% -40% of cases, while systemic spread is uncommon with distant extra-pelvic metastasis recorded in 5% -8% at onset, and rates of metastatic progression after primary treatment between 10% and Acta facultatis medicae Naissensis 2016;33(4):295-306 (25). The inguinal area radiation in the dose of [30][31][32][33][34][35][36] Gy is applied in case of positive lymph nodes in the inguinal region (13). The sentinel lymph node biopsy (SLNB) can also be applied in case of recurrence after the CRT (13).…”

Cancers of the Anal Canal: Diagnosis, Treatment and Future Strategies

“…In addition, lymph node metastases may be present in lymph nodes less than 5 mm, making radiological confirmation difficult [55]. The use of sentinel lymph node biopsy has been advocated as a tool to reduce over treatment of the inguinal regions with radiotherapy [56]. The draining sentinel nodes have been detectable in 66-100% of cases [57].…”

“…Inguinal lymph node involvement at diagnosis is a poor prognostic indicator. Lymph node spread is an independent predictor of poorer locoregional control, reduced disease-free s urvival and reduced overall survival [13,56,76].…”