A New Concept for the Role of Ex vivo Sentinel Lymph Nodes in Node-Negative Colorectal Cancer

Märkl, Bruno; Arnholdt, H.; Jähnig, Hendrik; Spatz, Hanno; Anthuber, Matthias; Oruzio, Daniel; Kerwel, Therese G.

doi:10.1245/s10434-010-1030-3

Cited by 14 publications

(7 citation statements)

References 36 publications

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“…When the SLN procedure is used for nodal staging to determine prognosis and possible adjuvant therapy, as has been suggested for colorectal cancer, an ex vivo approach can be considered 58. Using an ex vivo approach, more optimised NIR fluorescent dyes can be used, which are not yet approved for in vivo administration, such as IRDye 800CW (LI‐COR, Lincoln, NE).…”

Section: Sentinel Lymph Node Mappingmentioning

confidence: 99%

The clinical use of indocyanine green as a near‐infrared fluorescent contrast agent for image‐guided oncologic surgery

Schaafsma

Mieog

Hutteman

et al. 2011

Journal of Surgical Oncology

711

592

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Optical imaging using near-infrared (NIR) fluorescence provides new prospects for general and oncologic surgery. ICG is currently utilised in NIR fluorescence cancer-related surgery for three indications: sentinel lymph node (SLN) mapping, intraoperative identification of solid tumours, and angiography during reconstructive surgery. Therefore, understanding its advantages and limitations is of significant importance. Although non-targeted and non-conjugatable, ICG appears to be laying the foundation for more widespread use of NIR fluorescence-guided surgery.

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Section: Sentinel Lymph Node Mappingmentioning

confidence: 99%

The clinical use of indocyanine green as a near‐infrared fluorescent contrast agent for image‐guided oncologic surgery

Schaafsma

Mieog

Hutteman

et al. 2011

Journal of Surgical Oncology

711

592

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“…In 1975, Ponsky et al rstly proposed preoperative colonoscopic tattooing for surgeons to localize tumors at operation [43]. Later, widely using dyes including ICG, CNs, methylene blue, and indigo carmine, it had been accepted that an important advantage of dyes was real-time visualization of regional LNs without radiation expose and might heighten the sensitivity of LNs metastasis detection [42,44,45]. The proper molecular weight and hydrodynamic diameter of ICG and CNs render them the promising lymphatic contrast tools to when they enter the regional lymphatic system by peritumoral injection [46,47].…”

Section: Discussionmentioning

confidence: 99%

Regional Lymph Nodes Distribution Pattern in Central Area of Right-sided Colon Cancer: In-Vivo Detection and the Update on the Clinical Exploration.

Feng

et al. 2020

Preprint

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BackgroundDistribution of regional lymph nodes (LNs) is decisive for the lymphadenectomy boundary in radical resection of a right-sided colon cancer (RCC). Currently, the data of LNs in central area remains ambiguous and scarce. Herein we aim to provide a more detailed anatomical research on LNs surrounding the superior mesenteric vessels for RCC and investigated the metastasis rate.MethodsCarbon Nanoparticles (CNs) or Indocyanine Green (ICG) were used as dye and we laparoscopically observed the stained LNs distribution pattern and analyzed the harvested LNs combined with pathology report. Lastly, 137 RCC patients who received a “superior mesenteric artery (SMA)-oriented” hemicolectomy from September 2016 to September 2020 were included to calculate the probability of LNs metastasis in our target area.Results20 patients diagnosed as RCC (mean age 55.55 years, 13 male) were included. 13 patients underwent CNs injection and 7 patients consented to the ICG, while 4 cases suffered from imaging failure. The unequal number of the regional LNs located between SMV and SMA was detected in 17 cases (85%), posterior to SMV area in 6 cases (30%), and anterior to SMA in 11 cases (55%), respectively. The presence of LNs posterior to SMV was associated with the crossing pattern of ileocolic artery (²= 5.38, p= 0.020). The probability of LNs metastasis in the above areas (target areas) was 2.19% (3/137). No dyed LNs occurred when the SMA sheath was exposed. What’s more, the number of total harvested LNs in patients with dye injection was significant more than dye-free RCC patients (22.44±13.78 vs 43.20±22.70, p<0.01). ConclusionRight-hemi colon-draining lymphatic vessels anteriorly/posteriorly traversed the SMV and arrived at the surface of SMA near the middle colonic artery (MCA) level, which highlights the potential need of CME to place the internal border anterior to SMA and the removal of mesenteric tissue in our target area on lymphatic resection.

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“…1 There is growing evidence that these deposits are of high prognostic relevance. However, the current 7th edition of the tumor, node, metastasis system (TNM) classification was not yet available when we submitted our manuscript for consideration, and therefore it is not applicable to our study.…”

Section: To the Editorsmentioning

confidence: 99%

“…Our concept of ex vivo SLN mapping, however, does not influence standard histopathological examination, which includes tumor sampling and the evaluation of all nodular structures. 1 The classification of tumor deposits was changed in each of the last three TNM editions and remains controversial. Therefore, the suitability of these classifications for scientific purposes seems questionable.…”

Section: To the Editorsmentioning

confidence: 99%

Reply to “Ex Vivo Sentinel Lymph Nodes in Pathological Staging of Node-Negative Colorectal Carcinoma,” by Peparini and Chirletti

Märkl

Kerwel

2010

Ann Surg Oncol

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TO THE EDITORS:We agree with Peparini and Chirletti's remark on our article that tumor satellites are an important issue in the field of colorectal cancer.1 There is growing evidence that these deposits are of high prognostic relevance. However, the current 7th edition of the tumor, node, metastasis system (TNM) classification was not yet available when we submitted our manuscript for consideration, and therefore it is not applicable to our study. 2It is correct that sentinel lymph node (SLN) mapping does not facilitate the detection of deposits. Moreover, when the lymph node examination is limited to the SLN, tumor satellites would probably go undetected. Our concept of ex vivo SLN mapping, however, does not influence standard histopathological examination, which includes tumor sampling and the evaluation of all nodular structures. 1The classification of tumor deposits was changed in each of the last three TNM editions and remains controversial. Therefore, the suitability of these classifications for scientific purposes seems questionable. We investigated the origin of tumor deposits in a recently published study.3 In 50% of the deposits, a distinct origin (continuous growth, venous, lymphatic, nerve sheath invasion) could be found in corresponding step sections. Neither size nor shape of the satellites was associated with their origin. In other words, in none of the last three TNM editions were the majority of deposits correctly classified. The changes between the editions cause dramatic stage shifts, reducing the comparability of cases classified according to different editions.Interestingly, Puppa et al. hypothesized that at least a part of tumor deposits represent a special type of aggressive vascular invasion with similarity to in-transit metastasis of malignant melanoma. Therefore, they propose a classification as pM1a. 4 In conclusion, the problem of correct tumor deposit classification is not sufficiently solved yet.

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A New Concept for the Role of Ex vivo Sentinel Lymph Nodes in Node-Negative Colorectal Cancer

Abstract: Combination of methylene blue technique and ex vivo sentinel mapping is feasible, easy to perform, and cost effective. It guarantees an optimal LN harvest and has the potential to heighten the sensitivity of metastasis detection.

Cited by 14 publications

References 36 publications

The clinical use of indocyanine green as a near‐infrared fluorescent contrast agent for image‐guided oncologic surgery

The clinical use of indocyanine green as a near‐infrared fluorescent contrast agent for image‐guided oncologic surgery

Regional Lymph Nodes Distribution Pattern in Central Area of Right-sided Colon Cancer: In-Vivo Detection and the Update on the Clinical Exploration.

Reply to “Ex Vivo Sentinel Lymph Nodes in Pathological Staging of Node-Negative Colorectal Carcinoma,” by Peparini and Chirletti

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