Clinical application of sentinel lymph node mapping in colon cancer:<i>in vivo</i>vs.<i>ex vivo</i>techniques

Oh, Seung Yeop; Kim, Do Yoon; Kim, Young Bae; Suh, Kwang Wook

doi:10.4174/astr.2014.87.3.118

Cited by 11 publications

(10 citation statements)

References 27 publications

(44 reference statements)

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“…15,16 Recently, SLN mapping has been tried to facilitate ELND and to improve stating accuracy in CC. 12,13,14,17 However, notwithstanding our results, the feasibility of SLN in CC seems to be controversial and still remains to be defined. Hence, this study was planned.…”

Section: Discussionmentioning

confidence: 77%

“…Lymph node status in CC is a major prognostic factor that determines the disease recurrence, survival, and the adjuvant treatment. 8,11,12,13,14 Disease recurrence still remains the most important problem after radical surgery likely due to inadequate lymph node dissection. The optimal number of LN required to accurately predicting lymph node negativity has been a point of debate.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sentinel Lymph Node Mapping in Colon Cancer Patients: Does Make A Sense?

Gündoğdu¹,

Çolak²,

Türkmenoğlu³

et al. 2020

tjcd

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Kolon Kanseri hastalarında Sentinel lenf nodu haritalandırması: Bir anlamı var mı? Amaç: Kolorektal kanserlerde (CC) lenf nodu tutulumu, hastalığın nüksü, sağkalım ve adjuvan tedaviye karar vermede majör prognostik faktör olarak değerlendirilir. Sentinel lenf nodu (SLN) meme ve melonomada patolojik değerlendirmeyi güçlendiren etkili bir teknik olsa da CC'de halen tartışmalıdır. Bu nedenle, bu çalışmada SLN'nin CC'de lenf nodu durumunu değerlendirmesindeki duyarlılığı, özgüllüğü ve doğruluğunu değerlendirmeyi amaçladık. Yöntem: Bu prospektif randomize çalışmaya, kolorektal kanser nedeniyle acil veya elektif ameliyata alınacak olan ardışık 84 hasta dahil edildi. Lenf nodu durumunu değerlendirmek için "in vivo" mavi boya ile haritalama yöntemi kullanıldı. Yöntemin duyarlılığı mavi boya ile ilk boyanan 3-4 lenf nodunun nihai patoloji raporuyla karşılaştırılarak değerlendirildi. Bulgular: SLN'nin metastatik lenf nodunu tahmin (%61,54) etmedeki belirleyiciliği az, yalancı-negatiflik oranı yüksek (%38,5), özgüllüğü %100, tahmin oranı %88,1 idi. Genel doğruluğu %81,08, negatifi tahmin değeri %82,76, pozitifi tahmin değeri ise %100 idi. Bizim çalışmamızda olduğundan daha ileri (upstaging) bir evreleme yapılmadı. Sonuç: Bu sonuçlar göz önünde bulundurulduğunda, SLN haritalaması, yüksek tespit oranına rağmen hastanın lenf nodu durumunu klinik olarak kabul edilebilir doğrulukla tahmin edemedi. Çalışmada bölgesel lenf nodu disseksiyonuyla birlikte yapılan "en bloc" tümör rezeksiyonunun CC'lerde halen standart tedavi yöntemi olduğunu vurgulamaktayız. SLN haritalaması düşük prediktif değerinden dolayı, operasyonun niteliğini değiştirmemelidir. Anahtar Kelimeler: Sentinel lenf nodu, kolorektal kanser, evreleme, lenf nodu metastazı Aim: Lymph node status in colon cancer (CC) is a major prognostic factor that determines the disease recurrence, survival, and the adjuvant treatment. Although sentinel lymph node (SLN) is an effective technique that improves pathologic assessment in breast cancer and melanoma, the feasibility and outcomes of SLN in CC is still controversial. Hence, we aimed to evaluate the sensitivity, specificity, and accuracy of SLN for determining lymph node status in CC. Method: A total of 84 consecutive patients undergoing urgent or elective colectomy for colon cancer were enrolled in this prospective randomized study. In vivo SLN mapping with blue dye was used to evaluate the lymph node status. The sensitivity of the method was evaluated by comparing the pathologic condition of 3-4 blue dyed lymph nodes with final conventional pathologic assessment. Results: The sensitivity of identification for SLN was low (61.54%) for predicting lymph node metastasis, false-negative rates were high (38.5%), specificity was 100%, the detection rate was 88.1%, the overall accuracy rate was 81.08% , negative predictive value 82.76%, and positive predictive value was 100%. No upstaging was determined in our study. Conclusion: Considering our results, SLN mapping could not predict the nodal status with clinically acceptable accurac...

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Mapping in Colon Cancer Patients: Does Make A Sense?

Gündoğdu¹,

Çolak²,

Türkmenoğlu³

et al. 2020

tjcd

View full text Add to dashboard Cite

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“…Furthermore, ICG-FI is not influenced by the patient's BMI nor by lymphatic invasion, as has been shown for conventional methods, and has been shown to increase SLN detection in comparison with standard techniques (16,18). Although the ex vivo blue dye technique in SLN detection in CRC is well documented in the literature and has been demonstrated to be as effective and sensitive as the in vivo technique (19,20), no study has yet evaluated the role of ICG-FI using the ex vivo technique for SLN detection.…”

Section: Discussionmentioning

confidence: 99%

“…Seventy percent of included patients had pT3-4 tumors. This could cause a higher risk of missed metastases due to lymphatic channel blockages (20). This is problematic as these patients are probably the most at-risk for developing further metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Liberale

Vankerckhove

Galdón

et al. 2016

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Abstract. Background In patients with colorectal cancer (CRC), the accurate establishment of the pathological status of tumor-draining mesenteric lymph nodes (LN) is of central importance for therapeutic management. In patients with stage III disease with demonstrated LN metastases, adjuvant systemic chemotherapy is indicated, reducing the risk of recurrence and improving long-term overall survival (1). The accuracy of mesenteric nodal staging depends primarily on the number of resected LN, and the seventh American Joint Committee on Cancer (AJCC) edition recommends harvesting and analysis of at least 12 to 14 LN for correct staging (2). Despite this, 20-30% of patients with no LN metastases demonstrated at pathology (pN0), and therefore classified as stage II, still develop recurrent disease (3). These recurrences could potentially be associated with unrecognized locoregional nodal metastases, which could lead to understaging and undertreatment.The sentinel lymph node (SLN) is defined as the first LN draining the primary tumor. In melanoma and breast cancer, it has been shown that pathological status of the SLN is indicative of the risk of nodal metastases, thus providing an indication for lymphadenectomy when SLN pathological examination is positive and for avoiding mutilating surgery when it is negative (4, 5). The concept, and potential utility, of the SLN is different in CRC since mesenteric lymphadenectomy is systematically performed during surgery for the primary tumor. In patients with CRC, the particular contribution of SLN examination could be to focus the pathological analysis specifically on draining LNs in order to improve the sensitivity for cancer cell detection by the use of advanced methods, such as serial sectioning, immunohistochemistry (IHC), and molecular analyses such as reverse transcriptase polymerase chain reaction (RT-PCR) to increase pathological staging (6).Accordingly, a recent meta-analysis concluded that the use of SLN examination allowed for nodal up-staging of patients with CRC, providing a potential benefit (7). However, the technique of SLN analysis is still not widely used in patients with CRC. This could be related to the variability of the sensitivity of techniques for SLN detection which ranges from 33% to 100%, to the risk of missed metastases, and also to uncertainty related to the clinical significance and prognostic value of nodal micrometastases in CRC (7-9).Recently, fluorescence imaging (FI) using indocyanine green (ICG) has emerged as a new technique for SLN detection in various tumors (10)(11)(12). Only few studies have 4853

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“…24 Further studies failed to improve a great deal on these results with large variations in the reported detection rates, sensitivity and false-negative rates, which have been variously attributed to heterogeneity in detection techniques, definition of the SLN, time interval between injection and SLN detection, histopathological techniques, and patient characteristics, including tumour stage and body mass index. 25 A recent meta-analysis showed a SLN identification rate of 92% with a pooled sensitivity rate for detecting LN metastases of 69.6% (range 33.3-100%) and a false-negative rate of 30.4%. 26 Importantly, concerns have been expressed regarding the high false-negative rates and whether metastases from colon cancer follow an orderly spread through tiers of LNs, or rather metastasise as skip lesions.…”

Section: Sentinel Lymph Node Mappingmentioning

confidence: 99%

Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten): a multicentre, multinational feasibility study of fluorescence in predicting lymph node-positive disease

et al. 2016

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Background5-aminolevulinic acid (5-ALA) is used for fluorescence diagnosis (FD) in neurological, gynaecological and urological malignancies. The Medical Research Council/Efficacy and Mechanism Evaluation (EME) programme/National Institute for Health Research’s Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten) study investigated its use to predict lymph node (LN)-positive disease in colon cancer as an aid to stratified surgery.ObjectivesThe primary objective was to optimise the dose of oral 5-ALA for intraoperative FD of metastatic LNs in colon cancer. Secondary objectives included standardisation of pre-operative computerised tomography (CT) LN reporting, intraoperative fluorescence detection, surgical resection with D3 lymphadenectomy and histopathological examination of resected specimens.DesignThis was a feasibility study to determine optimal strategies for 5-ALA positive LN detection. Patients with locally advanced disease identified using the Fluoropyrimidine, Oxaliplatin and Targeted-Receptor pre-Operative Therapy for patients with high-risk, operable colon cancer (FOxTROT) criteria were recruited from two sites between October 2013 and June 2015. Cohort 1 received 20 mg/kg and cohort 2 received 30 mg/kg of oral 5-ALA, 1–6 hours preoperatively. Laparoscopic assessment of fluorescence was performed using the Storz D-Light system (KARL STORZ GmbH & Co. KG; Tuttlingen, Germany), with marking of fluorescent LNs, followed by oncological resection. The specimen was subjected to histological analysis with step sectioning of marked fluorescent LNs. Progression to an evaluation phase using the optimal dosing schedule was dependent on positively identifying at least 2 out of 10 patients with metastatic LN disease in either cohort.ResultsA total of 44 patients were recruited with a male to female ratio of 26 : 18 and a mean age of 71 years (range 52–88 years). Cohort 1 consisted of 18 patients, of whom six had fluorescent primary cancers and three of these had fluorescent LNs. One out of 10 patients with metastatic LN disease had a fluorescent involved LN. Cohort 2 consisted of 26 patients, of whom eight had fluorescent primary cancers and four of these had fluorescent LNs. None of the fluorescent LNs contained disease in this cohort. No serious adverse events (SAEs) occurred but two mild, self-limiting, photosensitivity reactions were observed in cohort 2. The sensitivity and specificity for 5-ALA detection of LN-positive disease were: cohort 1 11.1%, 75%; and cohort 2 0%, 75%.LimitationsThis was a feasibility study exploring the use of 5-ALA for LN disease in a select cohort of patients with advanced colorectal cancer. The study population was small and generalisation to other cancers is not possible. The study was limited by the ability to determine LN-positive patients on the basis of pre-operative CT staging, which is often inaccurate, resulting in our cohorts containing several patients without LN disease.Conclusions5-ALA fluorescent diagnosis has poor sensitivity for discriminating LN-positive colon cancer. Its use as an aid to stratified colon cancer surgery is not supported. No SAEs were observed, suggesting that photosensitisers may be useful for intraoperative FD.Future work5-ALA has poor sensitivity for detecting LN metastases and cannot be recommended for intraoperative staging. Other, more sensitive fluorescent probes are required if this strategy is to be used.Study registrationCurrent Controlled Trials ISRCTN79949827 and EudraCT number 2012–002623–15.Funding detailsThis project was funded by the EME programme, a Medical Research Council and National Institute for Health Research partnership.

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Clinical application of sentinel lymph node mapping in colon cancer:in vivovs.ex vivotechniques

Cited by 11 publications

References 27 publications

Sentinel Lymph Node Mapping in Colon Cancer Patients: Does Make A Sense?

Sentinel Lymph Node Mapping in Colon Cancer Patients: Does Make A Sense?

Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten): a multicentre, multinational feasibility study of fluorescence in predicting lymph node-positive disease

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