Improving staging accuracy in colon and rectal cancer by sentinel lymph node mapping: A comparative study

Abstract

Please cite this article as: van der Zaag ES, Buskens CJ, Kooij N, Akol H, Peters HM, Bouma WH, Bemelman WA. Improving staging accuracy in colon and rectal cancer by sentinel lymph node mapping: a comparative study, European Journal of Surgical Oncology (2009Oncology ( ), doi: 10.1016Oncology ( /j.ejso.2009 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Results: A SN was identified in 117 patients (89%), and accurately predicted nodal status in 106 patients (accuracy 91%). Both sensitivity and negative predictive value was higher in colon carcinomas than in rectal carcinomas (83% versus 57%, p=0.06 and 93% versus 65%, p=0.002 respectively). In patients with extensive lymph node metastases the SN procedures was unsuccessful. Eleven of the 13 unsuccessful SN procedures were performed in patients with rectal cancer who had pre-operative radiotherapy. After immunohistochemical analysis 21 of the 73 N0 patients had occult tumour cells in their SN; 8 patients had micrometastases and 13 patients had isolated tumour cells.Conclusion: SN mapping accurately predicts nodal status in patients with colonic cancer.Immunohistochemical analysis demonstrates micrometastatic disease in eight out of 73 N0 patients, with a true upstaging rate of 11%. SN mapping is less reliable in patients with rectal cancer after pre-operative radiotherapy.

The effect of colonoscopic tattooing on lymph node retrieval and sentinel lymph node mapping

“…This would be in line with sentinel node mapping studies in which higher T-stage, pN2, and preoperative radiotherapy were identified as factors influencing sentinel node success rates. 12 This is probably because of tumoral obstruction of the lymphatics or radiotherapy-induced fibrosis leading to rerouting of the lymphatic flow. With the expected increase of endoscopic tattooing in the near future, gastroenterologists will become more experienced in the procedure.…”

“…If N0 patients are actually understaged N1 patients, they miss out on adjuvant chemotherapy, thereby significantly decreasing their survival. 11,12 Moreover, with the increasing implementation of CRC screening programs, a considerable rise in detection of T1 tumors is to be expected.…”

“…These patients at stage N1 8 will then receive adjuvant chemotherapy, leading to a better prognosis. [11][12][13] So far, sentinel node mapping has not been introduced as common practice for CRC, which is probably because of the overall disappointing sensitivity rates. 11 The aim of this retrospective study was to determine whether colonoscopic tattooing can increase the accuracy of tumor staging by analysis of the LN yield per specimen and its accuracy when used as a sentinel node procedure.…”

Decreased incidence of isolated tumor cells in lymph nodes after laparoscopic resection for colorectal cancer

“…Ex vivo sentinel lymph node mapping was used, as described previously in detail [7]. After resection, 0.5–2 ml patent blue (depending on the volume of the tumor) was injected below the subserosa, around the tumor, with the colonic specimen left intact.…”

Transrectal sentinel lymph node biopsy for early rectal cancer during transanal endoscopic microsurgery

“…In suspected invasive cancers, SLN mapping could be a useful technique to identify the first lymphnode receiving drainage from the tumour, whose accurate pathological examination could predict the status of the remaining nodes (11)(12)(13)(14)(15)(16)(17)(18). Near-infrared fluorescence (NIR) emitting dye indocyanine green (ICG) has been used in SLN mapping for breast, gastric and colon cancer (19)(20)(21)(22)(23)(24).…”