Sentinel Node Mapping does not Improve Staging of Lymph Node Metastasis in Colonic Cancer |
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Authors: | Arne E Faerden Ole H Sjo Solveig Norheim Andersen Beate Hauglann Naimy Nazir Berit Gravdehaug Ingvild Moberg Aud Svinland Arild Nesbakken Arne Bakka |
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Institution: | (1) Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Oslo, Norway;(2) Department of Digestive Surgery, Aker University Hospital, University of Oslo, Oslo, Norway;(3) Department of Pathology, Akershus University Hospital, University of Oslo, Oslo, Norway;(4) Department of Pathology, Aker University Hospital, University of Oslo, Oslo, Norway;(5) Department of Digestive Surgery, Akershus University Hospital, 1478 Lorenskog, Norway |
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Abstract: | Purpose This study was designed to evaluate the reliability of the sentinel node concept in colonic cancer.
Methods Patent blue was used as tracer. The four blue nodes closest to the tumor were defined as the sentinel node(s) by the pathologist.
All nodes were examined by routine microscopy (hematoxylin-eosin staining). If no metastases were detected, all lymph nodes
were examined immunohistochemically with antibody to cytokeratin.
Results Two hundred colon specimens were examined. Sentinel node(s) were identified in 93 percent. Sixty contained metastases in hematoxylin-eosin
sections. In 32 these were found in sentinel nodes (sensitivity 53 percent). Twenty-eight patients had metastases in nonsentinel
nodes only, giving a false-negative rate of 47 percent. Immunostaining revealed 39 (30 percent) micrometastases or submicrometastases
in 131 TNM Stages I and II patients, and in 17 of these patients metastases were found in nonsentinel nodes only (false-negative
rate 44 percent).
Conclusions Sentinel lymph node mapping shows low sensitivity for detection of ordinary metastases, micrometastases, and submicrometastases.
If only the sentinel nodes had been examined, approximately half of the metastases would have been lost after routine staining,
as well as half of the micrometastases and submicrometastases when immunohistochemical examination was added.
Presented as one of six best papers at the meeting of the European Society of Coloprotology-ESCP, Portomaso, Malta, September
26 to 29, 2007.
An erratum to this article can be found at |
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Keywords: | Sentinel node Colon carcinoma Lymph node metastasis Micrometastasis Immunohistochemistry |
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