Intraoperative sentinel lymph node mapping in patients with colon cancer

• Published in: The American journal of surgery Vol. 182; no. 1; pp. 40 - 43
• Main Authors: Paramo, Juan C, Summerall, Janna, Wilson, Christopher, Cabral, Amadeo, Willis, Irvin, Wodnicki, Henry, Poppiti, Robert, Mesko, Thomas W
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2001; Elsevier; Elsevier Limited
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Breast cancer; Cancer; Chemotherapy; Colon cancer; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Colorectal cancer; Female; Humans; Intraoperative Care; Lymph nodes; Lymphatic system; Male; Mapping; Medical sciences; Melanoma; Mesentery; Metastases; Metastasis; Middle Aged; Patients; Prospective Studies; Rosaniline Dyes; Sectioning; Sensitivity and Specificity; Sentinel Lymph Node Biopsy - methods; Sentinel lymph node mapping; Stains & staining; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tumors; Colon cancer; Sentinel lymph node mapping; Human; Sentinel lymph node; Intraoperative; Surgical resection; Metastasis; Malignant tumor; Color tracers; Lymphatic vessel disease; Colonic disease; Treatment; Surgery; Digestive diseases; Intestinal disease; Colon; Diagnosis; Technique
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(01)00658-4

Background: The sentinel lymph node (SLN) mapping technique has been used in breast cancer and melanoma, and was recently described for colon cancer. Methods: Thirty-five patients with colon cancer underwent intraoperative SLN mapping. One milliliter of 1% isosulfan blue was injected subserosally around the tumor. The first nodal area that was highlighted with blue was identified as the SLN. All lymph nodes underwent examination with hematoxylin and eosin (H&E) stain. SLNs underwent additional sectioning and were stained with CAM 5.2. Results: Lymphatic mapping adequately identified the SLN in 25 patients (71%). In the 15 cases where the SLNs were negative for metastases, all other non-SLNs were also negative (0% false negative rate). The SLN was the only site of metastases in 6 (17%) of 35 patients. CAM 5.2 staining provided the only evidence of micrometastases in 4 (11%) of 35 patients. Conclusions: Intraoperative SLN mapping is a feasible technique with a reasonable SLN identification rate (71%). The absence of metastases in the SLNs accurately predicts the status of the non-SLNs. Tumors in 11% of patients were upstaged by the demonstration of micrometastatic involvement, and these patients may benefit from further adjuvant chemotherapy.