Validation of Ex Vivo Lymphatic Mapping in Hematoxylin-Eosin Node-Negative Carcinoma of the Colon and Rectum

Wong, Jan H.; Johnson, D. S.; Namiki, Thomas; Tauchi-Nishi, Pamela

doi:10.1245/aso.2004.11.026

Cited by 41 publications

(25 citation statements)

References 26 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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“…Blue stained lymphatic channels and lymph nodes are identified in the mesentery and harvested separately. 26,[45][46][47][48] SLN mapping was performed laparoscopically in three studies. 21,24,25 Besides the laparoscopic approach and intraoperative colonoscopy for submucosal injection of blue dye, the technique was comparable to the open procedure.…”

Section: Sln Mapping Using Blue Dyementioning

confidence: 99%

Sentinel Lymph Node Mapping in Colon Cancer: Current Status

et al. 2007

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Background: The primary role of sentinel lymph node (SLN) mapping in colon cancer is to increase the accuracy of nodal staging by identifying those lymph nodes with the greatest potential for harbouring metastatic disease. Ultrastaging techniques aim to identify the otherwise undetected metastases. Until now, no consensus exists as to the most optimal procedure in patients with colon cancer.Methods: A systematic literature search on the value of different SLN mapping techniques in patients with colon cancer was performed using the electronic search engine PubMed. Prospective studies published before 1 December 2005 were included and further articles were selected by cross-referencing. The results of different techniques using either blue dye or radiocolloid, were investigated.Results: The literature search yielded 17 relevant articles. SLN mapping using blue dye was described in 15 studies. Two studies reported the results of SLN mapping using a combination of blue dye and radiocolloid. The reported results on identification rate varied between 71 and 100%. Accuracy rates were between 78 and 100%, sensitivity rates between 25 and 100% and true upstaging rates between 0 and 26%. The results were not affected by the addition of radiocolloid to blue dye.Conclusions: Sentinel lymph node mapping in patients with colon cancer remains an experimental procedure with varying results. Further evaluation may lead to a standardized technique that offers the potential for significant upstaging of stage II patients. This may have important implications as to tailor adjuvant chemotherapeutic regimens in these patients.

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“…When technical difficulties are present and SN mapping fails, the ex vivo mapping is performed as a salvage technique. Some authors have performed only this ex vivo technique [24,25], but in our opinion in vivo mapping has a relevant role. This is because it detects aberrant lymphatic drainage (7.1% in this series), avoids the interruption of the lymphatic pathway by any surgical manipulation, and because the direct visualization of lymphatic pathway, particularly in laparoscopic surgery, gives a clearer identification of the lymph nodes basin, helping the surgeon execute a radical lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

Technique of sentinel lymph node biopsy and lymphatic mapping during laparoscopic colon resection for cancer

Bianchi¹

2015

ecancer

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Validation of Ex Vivo Lymphatic Mapping in Hematoxylin-Eosin Node-Negative Carcinoma of the Colon and Rectum

Abstract: If the SLN is negative by both H&E and IHC analysis, the probability of finding metastases in a non-SLN is remote. If microstaging is demonstrated to be prognostically relevant, focused examination should be of the SLN(s).

Cited by 41 publications

References 26 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

Sentinel Lymph Node Mapping in Colon Cancer: Current Status

Technique of sentinel lymph node biopsy and lymphatic mapping during laparoscopic colon resection for cancer

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