Ex vivo sentinel lymph node investigation in colorectal cancer

Journal of Coloproctology - Tập 33 - Trang 16-21 - 2013
Antônio Hilário Alves Freitas1,2, Alberto Julius Alves Wainstein2, Tarcizo Afonso Nunes3
1Brazilian Society of Coloproctology, Rio de Janeiro, RJ, Brazil
2Trymed Clinical Research, Belo Horizonte, MG, Brazil
3Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

Tóm tắt

AbstractIntroduction In Brazil, about 26,000 cases of colorectal cancer are diagnosed per year. Pa- tients considered at the early stage of disease (without lymph node) evolve with tumor relapse or recurrence in up to a quarter of cases, probably due to understaging.Objective Research on ex vivo sentinel lymph node in patients with colorectal adenocarcinoma.Materials and methods We studied 37 patients who underwent curative surgical resection. The marker used to identify lymph nodes was patent blue dye injected into the peritu- moral submucosa of the open surgical specimen immediately after its removal from the abdominal cavity.Results  Ex vivo identification of sentinel lymph node with marker occurred in 13 (35.1%) patients. The sensitivity was 40% and 60% false negative. The detailed histological examina- tion of sentinel lymph nodes with multilevel section and immunohistochemistry showed metastasis in one (4.3%) individual, considered ultra-staging.Conclusion The ex vivo identification of sentinel lymph node had questionable benefits, and worse results when include patients with rectal cancer. Restaging of one patient was possible after multilevel section and immunohistochemistry of the sentinel lymph node, but more research is needed to evaluate the role of micrometastases in patients with colorectal cancer.

Tài liệu tham khảo

World Health Organization (WHO), 2008. Available at: http://www.who.int/cancer. Morton, 1992, Technical details of intraoperative lymphatic mapping for early stage melanoma, Arch Surg, 127, 392, 10.1001/archsurg.1992.01420040034005 Gordon PH, Nivatvongs S. Principles and practice of surgery for the colon, rectum, and anus, 2.ed. St. Louis, Missouri: Quality Medical Publishing, Inc., 1999. Wolmark, 1996, The relative efficacy of 5-FU + leucovorin (LV-FU), 5-FU + levamisole (Lev-FU) and leucovorin, 5-FU + + levamisole (Lev-LV-FU) in Patients with Dukes B and C of the carcinoma colon: first report of NSABP C-04 [abstract 460], Proc Am Soc Clin Oncol, 15, 205 Bilchick, 2002, Lymphatic mapping of nodal micrometastasis in colon cancer: putting the cart before the horse?, Ann Surg Oncol, 9, 529, 10.1007/BF02573886 Bertoglio, 2004, Prognostic value of sentinel lymph node biopsy in the pathologic staging of colorectal cancer Patients, J Surg Oncol, 85, 166, 10.1002/jso.20030 Saha, 2006, A multicenter trial of sentinel lymph node mapping in colorectal cancer: Prognostic Implications for nodal staging and recurrence, Am J Surg, 191, 305, 10.1016/j.amjsurg.2005.10.028 Greene FL, Balch CM, Fleming ID (eds.). AJCC Cancer Staging Handbook: TNM classification of Malignant Tumors. New York: Springer-Verlag, 2009. p. 129. Braithwaite, 1923, Flow of lymph from the ileocecal angle, Br J Surg, 11, 7, 10.1002/bjs.1800114103 Wong, 2001, Ex vivo sentinel node mapping in carcinoma of the colon and rectum, Ann Surg, 233, 515, 10.1097/00000658-200104000-00006 Bell, 2005, Tiret E.Ex vivo sentinel lymph node mapping in colorectal cancer, Dis Colon Rectum, 48, 74, 10.1007/s10350-004-0782-x Demirbas, 2004, Should sentinel lymph node mapping for colorectal cancer be performed?, Turk J Gastroenterol, 5, 39 Smith, 2006, Ex vivo sentinel lymph node mapping in colon cancer: Improving the accuracy of pathologic staging?, Am J Surg, 191, 665, 10.1016/j.amjsurg.2006.01.045 Sommariva, 2010, Factors Affecting false-negative rates on ex vivo sentinel lymph node mapping in colorectal cancer, Eur J Surg Oncol, 36, 130, 10.1016/j.ejso.2009.06.007 van der Zaag, 2009, Improving staging accuracy in colon and rectal cancer by sentinel lymph node mapping: a comparative study, Eur J Surg Oncol, 35, 1065, 10.1016/j.ejso.2009.02.001 Ceranic MS, Kecmanovic DM, Pavlov MJ, Nale DP, Micev MT, Kovacevic PA, et al. Validation and feasibility of ex vivo sentinel lymph node “mapping” by methylene blue in colorectal cancer. Hepatogastroenterology 2010; 57(102-103):1113-8. Freitas, 2008, Search sentinel lymph node in patients with colon cancer, Rev Bras Coloproct, 28, 170, 10.1590/S0101-98802008000200004 Wong, 2004, Validation of ex vivo lymphatic mapping in Hematoxylin-eosin node- negative carcinoma of the colon and rectum, Ann Surg Oncol, 11, 772, 10.1245/ASO.2004.11.026 Benson, 2004, American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer, J Clin Oncol, 22, 3408, 10.1200/JCO.2004.05.063 Rossi, 2006, Number of dissected lymph nodes in colorectal cancer Patients Submitted to radical surgery: the quality of oncology treatment, Applied Cancer Research, 26, 27 Quadros, 2010, Suggestion of optimal patient characteristics for sentinal lymph node mapping in colorectal adenocarcinoma, Arq Gastroentelol, 47, 344, 10.1590/S0004-28032010000400005 Dess Guetz, 2007, Is sentinel lymph node mapping in colorectal cancer a future Prognostic factor?. A meta-analysis, World J Surg, 31, 1304, 10.1007/s00268-007-9012-8 Tiffet, 2007, Dubois Combining radioisotopic and blue- dye technique does not Improve the false-negative rate in sentinel lymph node mapping for colorectal cancer, Dis Col Rectum, 50, 962, 10.1007/s10350-007-0236-3 Joosten, 1999, Intraoperative lymphatic mapping and the sentinel node concept in colorectal carcinoma, Br J Surg, 86, 482, 10.1046/j.1365-2168.1999.01051.x Doekhie, 2005, The feasibility and reliability of sentinel node mapping in colorectal cancer, Eur J Oncol Soc, 31, 854, 10.1016/j.ejso.2005.05.011 Tuech, 2004, Sentinel lymph node mapping in colon cancer, Surg Endosc, 18, 1721, 10.1007/s00464-004-9031-6 Kitagawa, 2002, Sentinel node mapping for colorectal cancer with radioactive tracer, Dis Colon Rectum, 45, 1476, 10.1007/s10350-004-6453-0 Wainstein AJA, Barroso AA, Belfort AF. Significance of sentinel lymph node in cancer of the digestive tract. Topics in gastroenterology 14. Publisher Medsi, Rio de Janeiro, RJ, 2004. Steenbergen, 2010, Improving lymph node detection in colon câncer in community hospitals and their pathology department in southern Netherlands, Eur J Surg Oncol, 36, 135, 10.1016/j.ejso.2009.05.012 Paraf, 2000, Optimal lymph node number and occult lymph node metastases in colorectal cancer: the pathologists view, Gastroenterol Clin Biol, 24, 423 Tschmelitsch, 2000, Lymph node micrometastases not predict relapse in stage II colon cancer, Ann Surg Oncol, 7, 601, 10.1007/BF02725340 Cohen, 1998, Candeh F. Adjuvant therapy for colorectal cancer, Curr Prob Cancer, 22, 5, 10.1016/S0147-0272(98)90008-3 Codignola, 2005, Is there any role for sentinel node mapping in colorectal cancer staging? Personal experience and review of the literature, Jpn J Clin Oncol, 35, 645, 10.1093/jjco/hyi182 Bembenek, 2005, Detection of lymph node micrometastases and isolated tumor cells in sentinel and nonsentinel lymph nodes of colon cancer patients, World J Surg, 29, 1172, 10.1007/s00268-005-0094-x Bendavid, 2002, study on sentinel lymph node mapping in colon cancer: a preliminary report, J Surg Oncol, 79, 81, 10.1002/jso.10052