Sentinel Lymph Node Staging in Colon Cancer. Experience in 250 Cases

Authors

  • J. D. Sardon Ramos Department of Surgery, Alava-Txagorritxu University Hospital, Spain
  • J. Errasti Alustiza Department of Surgery, Alava-Txagorritxu University Hospital, Spain
  • E. Campo Cimarras Department of Surgery, Alava-Txagorritxu University Hospital, Spain
  • B. Cermeño Toral Department of Surgery, Alava-Txagorritxu University Hospital, Spain
  • J. A. Romeo Ramirez Department of Surgery, Alava-Txagorritxu University Hospital, Spain
  • L. Fernandez Rico Department of Surgery, Alava-Txagorritxu University Hospital, Spain
  • J. Saenz de Ugarte Sobrón Department of Surgery, Alava-Txagorritxu University Hospital, Spain
  • M. Cuadra Cestafe Department of Surgery, Alava-Txagorritxu University Hospital, Spain
  • A. Maqueda Merino Department of Surgery, Alava-Txagorritxu University Hospital, Spain
  • B. Atares Pueyes Department of Pathology, Alava-Txagorritxu University Hospital, Spain

DOI:

https://doi.org/10.12974/2309-6160.2014.02.02.1

Keywords:

Sentinel lymph node, ex vivo technique, methylene blue, colon cancer, upstaging.

Abstract

Background: The level of lymph node involvement is the most important factor in staging colorectal cancer without metastasis. Sentinel lymph node mapping identifies the node(s) that most accurately reflect the lymph node status of patients and intensive techniques that improve staging can be focused on these nodes. Objective: The aim of this study was to assess the efficacy of ex vivo sentinel lymph node mapping in the staging of colon cancer. Design: The selection of the cohorts was carried out on a prospective basis from September 2009 to April 2013, including all cases with no randomisation. Settings: Patients from the Alava University Hospital health region (Alava–Basque Country) in Spain. Patients: Study of 250 patients diagnosed prior to surgery with colon cancer without distant metastasis. A comparative study was also performed based on a control group of 170 patients staged with conventional techniques, involving a single slice and haematoxylin-eosin staining, from June 2006 to February 2009. Interventions: In these patients, we used ex vivo sentinel lymph node mapping with methylene blue, studying the sentinel nodes with multiple slices and immunohistochemical techniques as well as haematoxylin-eosin staining. Main outcome measures: The main outcome variable was change in staging after the Sentinel lymph node mapping. Results: The Sentinel lymph node identification rate was 98%, with 3.7% of false negatives. Upstaging occurred in 11% of cases compared to the group studied using conventional techniques. Limitations: The patients are not randomly selected and are compared with a retrospective series. Conclusions: Ex vivo Sentinel lymph node mapping with methylene blue accurately reflects the lymph node status of patients with colon cancer. This approach upstages patients classified as stages I and II by conventional techniques to stage III, indicating chemotherapy that may improve their prognosis. 

References

O’Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst. 2004; 96: 1420-5. http://dx.doi.org/10.1093/jnci/djh275

Greene FL, Page DL, Fleming ID, Fritz A, Balch C, Haller D, Morrow M, editors. AJCC Cancer staging handbook. 6th ed. Nueva York: Springer Verlag; 2002.

Cohen AM, Kelsen D, Saltz L, Minsky BD, Nelson H, Farouk R, et al. Adjuvant therapy for colorectal cancer. Curr Probl Cancer. 1998; 22: 5-65. http://dx.doi.org/10.1016/S0147-0272(98)90008-3

Saha H, Dan AG, Beutler T, Wiese D, Schochet E, Badin J, et al. Sentinel node lymph mapping technique in colon cancer. Semin Oncol. 2004; 31: 374-81. http://dx.doi.org/10.1053/j.seminoncol.2004.03.008

Compton CC, Greene FL. The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin. 2004; 54: 295-308. http://dx.doi.org/10.3322/canjclin.54.6.295

Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol. 2002; 26: 179-89. http://dx.doi.org/10.1097/00000478-200202000-00004

Le Voyer TE, Sigurdson ER, Hanlon AI, Mayer RJ, Macdonald JS, Catalano PJ, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of Intergroup Trial INT-0089. J Clin Oncol. 2003; 21: 2912-9. http://dx.doi.org/10.1200/JCO.2003.05.062

Swanson RS, Compton CC, Stewart AK, Bland KI. The prognosis of T3N0 colon cancer is dependent upon the number of lymph nodes examined. Ann Surg Oncol. 2003; 10: 65-71. http://dx.doi.org/10.1245/ASO.2003.03.058

Brown HG, Luckasevic TM, Medich DS, Celebrezze JP, Jones SM. Efficacy of manual dissection of lymph nodes in colon cancer resections. Mod Pathol. 2004; 17: 402-6. http://dx.doi.org/10.1038/modpathol.3800071

Rodriguez-Bigas MA, Maamoun S, Weber TK, Penetrante RB, Blumenson LE, Petrelli NJ. Clinical significance of colorectal cancer: metastases in lymph nodes <5mm in size. Ann Surg Oncol. 1996; 3: 124-30. http://dx.doi.org/10.1007/BF02305790

Bilchik AJ, DiNome M, Saha S, Turner RR, Wiese D, McCarter M, et al. Prospective multicenter trial of staging adequacy in colon cancer. Preliminary results. Arch Surg. 2006; 141: 527-34. http://dx.doi.org/10.1001/archsurg.141.6.527

Quadros CA, Lopes A, Araujo I, Fregnani JH, Fahel F. Upstaging benefits and accuracy of sentinel lymph node mapping in colorectal adenocarcinoma nodal staging. J Surg Oncol. 2008; 98: 324-30. http://dx.doi.org/10.1002/jso.21112

Viehl CT, Hamel CT, Marti WR, Guller U, Eisner L, Stammberger U, et al. Identification of sentinel lymph nodes in colon cancer depends on the amount of dye injected relative to tumor size. World J Surg. 2003; 27: 1285-90. http://dx.doi.org/10.1007/s00268-003-7086-5

De Hass RJ, Wicherts DA, Hobbelink MG, Borel Rinkes IH, Schipper ME, van der Zee JA, et al. Sentinel lymph node mapping in colon cancer: current status. Ann Surg Oncol. 2007; 14: 1070-80. http://dx.doi.org/10.1245/s10434-006-9258-7

International Breast Cancer Study Group. Prognostic importance of occult axillary lymph node micrometastases from breast cancers. Lancet. 1990; 335: 1565-68.East JM, Valentine CS, Kanchev E, Blake GO. Sentinel lymph node biopsy for breast cancer using methylene blue dye manifests a short learning curve among experienced surgeons: a prospective tabular cumulative sum (CUSUM) analysis. BMC Surg. 2009; 9:2.

Saha S, Dan AG, Viehl CT, Zuber M, Wiese D. Sentinel lymph node mapping in colon and rectal cancer: its impact on staging, limitations, and pitfalls. In: Leong SPL, Kitagawa Y, Kitajima M, editors. Selective sentinel lymphadenectomy for human solid cancer. Nueva York: Springer; 2005; p. 105-22. http://dx.doi.org/10.1007/0-387-23604-X_5

Bertagnolli M, Miedema B, Redston M, Dowell J, Niedzwiecki D, Fleshman J, et al. Sentinel node staging of resectable colon cancer: results of a multicenter study. Ann Surg. 2004; 240: 624-30.

Giuliano AE. Mapping a pathway for axillary staging: a personal perspective on the current status of sentinel lymph node dissection for breast cancer. Arch Surg. 1999; 134: 195-9. http://dx.doi.org/10.1001/archsurg.134.2.195

Wood TF, Saha S, Morton DL, Tsioulias GJ, Rangel D, Hutchinson W, et al. Validation of lymphatic mapping in colorectal cancer: in vivo, ex vivo, and laparoscopic techniques. Ann Surg Oncol. 2001; 8:150-7. http://dx.doi.org/10.1007/s10434-001-0150-1

Wong JH, Steineman S, Calderia C, Bowles J, Namiki T. Ex vivo sentinel node mapping in carcinoma of the colon and rectum. Ann Surg. 2001; 233: 515-21. http://dx.doi.org/10.1097/00000658-200104000-00006

Yagci G, Unlu A, Kurt B, Can M, Kaymakcioglu N, Cetiner S, et al. Detection of micrometastases and skip metastases with ex vivo sentinel node mapping in carcinoma of the colon and rectum. Int J Colorectal Dis. 2007; 22:167-73. http://dx.doi.org/10.1007/s00384-006-0132-7

Saha S, Wiese D, Badin J, Beutler T, Nora D, Ganatra BK, et al. Technical details of sentinel lymph node mapping in colorectal cancer and its impact on staging. Ann Surg Oncol. 2000; 7: 120-4. http://dx.doi.org/10.1007/s10434-000-0120-z

Tsioulias GJ, Wood TF, Spirt M, Morton DL, Bilchik AJ. A novel lymphatic mapping technique to improve localization and staging of early colon cancer during laparoscopic colectomy. Am Surg. 2002; 68: 561-5.

Retter SM, Herrmann G, Schiedeck TH. Clinical value of sentinel node mapping in carcinoma of the colon. Colorectal Dis. 2011; 13: 855-9. http://dx.doi.org/10.1111/j.1463-1318.2010.02293.x

Van der Pas MH, Meijer S, Hoekstra OS, Riphagen II, de Vet HC, Knol DL, et al. Sentinel lymph node procedure in colon and rectal cancer: a systematic review and meta-analysis. Lancet Oncol. 2011; 12: 540-50. http://dx.doi.org/10.1016/S1470-2045(11)70075-4

Park JS, Chang IT, Park SJ, Kim BG, Choi YS, Cha SJ, et al. Comparison of ex vivo and in vivo injection of blue dye in sentinel lymph node mapping for colorectal cancer. World J Surg. 2009; 33: 539-46. http://dx.doi.org/10.1007/s00268-008-9872-6

Piñero A, Jiménez J, Merck B, Vázquez C and Grupo de Expertos. Reunión de consenso sobre la biopsia selectiva del ganglio centinela en el cáncer de mama. Sociedad Española de Senología y Patología Mamaria. Rev Esp Patol. 2007; 40: 91-5.

Kelder W, Braat AE, Karrenbeld A, Grond JA, De Vries JE, Oosterhuis JW, et al. The sentinel node procedure in colon carcinoma: a multi-centre study in The Netherlands. Int J Colorectal Dis. 2007; 22: 1509-14. http://dx.doi.org/10.1007/s00384-007-0351-6

Nicholl M, Bilchik AJ. Is routine use of sentinel node biopsy justified in colon cancer? Ann Surg Oncol. 2008; 15: 1-3. http://dx.doi.org/10.1245/s10434-007-9630-2

Downloads

Published

2014-07-25

How to Cite

Ramos, J. D. S., Alustiza, J. E., Cimarras, E. C., Toral, B. C., Ramirez, J. A. R., Rico, L. F., Ugarte Sobrón, J. S. de ., Cestafe, M. C., Merino, A. M., & Pueyes, B. A. (2014). Sentinel Lymph Node Staging in Colon Cancer. Experience in 250 Cases. Global Journal of Oncologists, 2(2), 25–30 . https://doi.org/10.12974/2309-6160.2014.02.02.1

Issue

Section

Articles