Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Wong, Jan H.; Steineman, Susan; Calderia, Christiano; Bowles, Jason; Namiki, Thomas

doi:10.1097/00000658-200104000-00006

Cited by 127 publications

(94 citation statements)

References 40 publications

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“…In vivo and ex vivo methods have been developed, but it seems necessary to combine this technique with advanced methods like immunohistochemistry or PCR to demonstrate an advantage in comparison to conventional dissection. [19][20][21] Therefore, it is questionable if these interesting techniques will find usage beyond specialized centers.…”

Section: Discussionmentioning

confidence: 99%

Methylene blue injection into the rectal artery as a simple method to improve lymph node harvest in rectal cancer

et al. 2007

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Adequate lymph node assessment in colorectal cancer is crucial for prognosis estimation and further therapy stratification. However, there is still an ongoing debate on required minimum lymph node numbers and the necessity of advanced techniques such as immunohistochemistry or PCR. It has been proven in several studies that lymph node harvest is often inadequate under routine analysis. Lymph nodes smaller than 5 mm are especially concerning as they can carry the majority of metastases. These small, but affected lymph nodes may escape detection in routine analysis. Therefore, fat-clearing protocols and sentinel techniques have been developed to improve accuracy of lymph node staging. We describe a novel and simple method of ex vivo methylene blue injection into the superior rectal artery of rectal cancer specimens, which highlights lymph nodes and makes them easy to detect during manual dissection. Initially, this method was developed for proving accuracy of total mesorectal excision. We performed a retrospective study comparing lymph node recovery of 12 methylene blue stained and an equal number of unstained cases. Lymph node recovery differed significantly with average lymph node numbers of 2777 and 1474 (Po0.001) for the methylene blue and the unstained group, respectively. The largest difference was found in size groups between 1 and 4 mm causing a shift in size distribution toward smaller nodes. Metastases were confirmed in 21 and 19 lymph nodes occurring in five and four cases, respectively. Hence, we conclude that methylene blue injection technique improves accuracy of lymph node staging by heightening the lymph node harvest in rectal resections. In our experience, it is a very simple time and cost effective method that can be easily established under routine circumstances.

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Section: Discussionmentioning

confidence: 99%

Methylene blue injection into the rectal artery as a simple method to improve lymph node harvest in rectal cancer

et al. 2007

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“…The principle applies not just to cutaneous melanoma but to breast cancer, 3 Merkel cell cancer, 16 squamous carcinoma of the skin and vulva and tumors of the gastrointestinal tract. 4,5 The position of the sentinel node is determined by the course of the lymphatics that drain the body site of the primary tumor rather than the fixed anatomic position of individual node(s) relative to the primary tumor. It is necessary to use a visible dye and/or radioactive marker to highlight the relevant afferent lymphatics and the lymph node that is their destination.…”

Section: Discussionmentioning

confidence: 99%

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

et al. 2004

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Lymphatic mapping and sentinel node biopsy are well-established techniques for staging and managing patients with melanoma, breast cancer and other malignancies that spread initially to the regional lymph nodes. Identification of tumor in the sentinel node is the most precise staging technique currently available. The sentinel node is the site of metastatic melanoma in approximately 20% of melanoma patients and if tumor is present in the sentinel node it is customary to perform a complete dissection of the lymph nodes of the affected nodal basin. This may be overtreatment for some patients as tumor is identified in the nonsentinel nodes of only one-third of sentinel node-positive melanoma patients treated by completion lymphadenectomy. If it were possible accurately to identify the minority of patients with tumor in the nonsentinel nodes, the patients most likely to benefit from lymphadenectomy, the remaining patients could be spared a potentially morbid operation that is unlikely to confer clinical advantage. In 90 patients with a melanoma-positive sentinel node, who subsequently had a completion lymphadenectomy, we evaluated and compared the capacity of characteristics of the primary melanoma and of the sentinel node to predict individuals likely to have tumor in nonsentinel nodes. We assessed the Breslow thickness of the primary, the amount of tumor in the sentinel node (relative tumor area) and, as an index of immune modulation of the sentinel node, the density of dendritic leukocytes in the nodal paracortex. The relative area of tumor in the sentinel node and Breslow thickness of the primary melanoma most accurately predicted the presence of tumor in the nonsentinel nodes (P ¼ 0.0001 in both cases-Wilcoxon rank sums). The presence of melanoma in the nonsentinel nodes was also predicted by the density of dendritic leukocytes in the paracortex (P ¼ 0.008-Wilcoxon rank sums). These three observations assessed alone and in combination predict the presence of tumor in the nonsentinel nodes with high accuracy. The same characteristics also significantly correlated with tumor recurrence (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0.0007) and death from melanoma (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0. Keywords: melanoma; sentinel node; tumor burden; immune suppression; tumor recurrence; melanoma deathThe techniques of lymphatic mapping and sentinel node biopsy were developed to improve the management of patients with high-risk (thick and deep) primary melanoma with a high potential for metastases, but no clinical evidence of metastatic spread.

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“…2 In the absence of distant metastases, the presence or absence of lymph node metastases appears to be the most important prognostic factor in patients with colorectal carcinoma. 3 Furthermore, the lymph node status is the primary determinant for adjuvant therapy after surgical resection. Randomized clinical trials have demonstrated a survival benefit for patients with Stage III colorectal carcinoma using 5-flurouracil and leucovorin.…”

Section: Methodsmentioning

confidence: 99%

A prospective evaluation of radiocolloid and immunohistochemical staining in colon carcinoma lymphatic mapping

Patten

Berger

Rodrı́guez-Bigas

et al. 2004

Cancer

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BACKGROUNDAlthough the utility of lymphatic mapping (LM) and sentinel lymph node (SLN) biopsy in patients with melanoma and breast carcinoma has been well documented, this same is not true for patients with colon carcinoma. The authors previously reported a high false‐negative rate for SLN biopsy in patients with colon carcinoma using isosulfan blue dye alone. The objective of the current study was to determine whether radiocolloid would increase the sensitivity of LM/SLN biopsy in patients with colon carcinoma.METHODSThe authors performed LM on 57 patients with colon carcinoma using both isosulfan blue dye and radiocolloid. The SLN(s) were identified by either their blue color or by increased radioactivity. The SLNs then underwent both routine histologic sectioning and immunohistochemical (IHC) staining for cytokeratins.RESULTSAn SLN was identified in 56 patients (98%). Radiocolloid was able to identify only 1 additional positive SLN (9%). Overall, it was found that the disease had metastasized to the lymph nodes in 22 patients, even though there was no evidence of disease in the SLN(s) in 11 of those 22 patients on routine histologic sectioning (false‐negative rate, 50%; sensitivity, 50%). In five patients, IHC of the SLN was the only indicator of metastatic disease. The inclusion of IHC‐positive SLNs in these calculations would decrease the false‐negative rate to 17% and would increase the sensitivity of SLN biopsy to 83%.CONCLUSIONSIn the current study, the addition of radiocolloid did not increase the sensitivity of detection of positive SLN(s) compared with the use of isosulfan blue dye alone. IHC of the SLN potentially may increase the sensitivity of LM and reduce the false‐negative rate. However, the long‐term prognostic significance of IHC in patients with colon carcinoma remains controversial. Cancer 2004. © 2004 American Cancer Society.

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Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Cited by 127 publications

References 40 publications

Methylene blue injection into the rectal artery as a simple method to improve lymph node harvest in rectal cancer

Methylene blue injection into the rectal artery as a simple method to improve lymph node harvest in rectal cancer

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

A prospective evaluation of radiocolloid and immunohistochemical staining in colon carcinoma lymphatic mapping

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