Detection of Lymph Node Micrometastases and Isolated Tumor Cells in Sentinel and Nonsentinel Lymph Nodes of Colon Cancer Patients |
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Authors: | Andreas Bembenek MD Ulrike Schneider MD Stephan Gretschel MD Joerg Fischer Peter M Schlag MD PhD |
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Institution: | 1. Department of Surgery and Surgical Oncology, Charité – University Medicine Berlin, Robert-R?ssle Cancer Center, Lindenbergerweg 80, Berlin, 10437, Germany 2. Department of Pathology, Charité – University Medicine Berlin, Robert-R?ssle Cancer Center, Lindenbergerweg 80, Berlin, 10437, Germany 3. Data Processing and Statistics, Charité – University Medicine Berlin, Robert-R?ssle Cancer Center, Lindenbergerweg 80, Berlin, 10437, Germany
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Abstract: | About 20% to 30% of colon cancer patients classified as node negative by routine hematoxylin-eosin (H&E) staining are found
to have micrometastases (MM) or isolated tumor cells (ITC) in sentinel lymph nodes (SLNs) if analyzed by step sections and
immunohistochemistry (IHC). Whether SLNs are in this respect representative for all lymph nodes was addressed in this study.
SLNs were identified using the intraoperative blue dye detection technique. If all lymph nodes (SLNs and non-SLNs) of a patient
were negative by routine H&E staining, they were step-sectioned and analyzed by IHC using pancytokeratin antibodies. We identified
at least one SLN in 47 of the 55 patients (85%) and examined a median of 26 lymph nodes per patient (range 10–59). By routine
H&E staining, 14 of the 47 patients showed lymph node metastases (30%); the remaining 33 were classified as node-negative.
In this group (33 patients), 1011 lymph nodes were analyzed by step sections and IHC: 14 of 70 SLNs. (20%) but only 37 of
941 non-SLNs (4%) had MM/ITC (p < 0.001). Furthermore, 13 of the 33 H&E-negative patients were found to have MM/ITC (39%). In 11 of the 13 patients, MM/ITC
were identified in both SLNs and non-SLNs in 1 patient in the SLN only, and in 1 patient in a non-SLN only (sensitivity for
the identification of MM/ITC: 92%; negative predictive value: 95%). The SLN biopsy is a valid tool to detect, as well as exclude,
the presence of MM/ITC in colon cancer patients. Our results may be of prognostic relevance and influence patient stratification
for adjuvant therapy trials. |
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