One hundred consecutive cases of sentinel lymph node mapping in early colorectal carcinoma: Detection of missed micrometastases

Thomas F. Wood, Dean T. Nora, Donald L. Morton, Roderick R. Turner, Decio Rangel, William Hutchinson, Anton J. Bilchik, M. Zenilman, Keith A. Kelly

Research output: Contribution to journalArticle

Abstract

Almost one third of patients with "node-negative" colorectal carcinoma (CRC) develop systemic disease. This implies that these patients have occult disease that is inadequately treated by surgery alone. We have coupled sentinel lymph node mapping and a focused pathologic examination to detect occult nodal micrometastases in CRC. Since 1996, sentinel lymph node mapping has been performed in 100 consecutive patients undergoing colectomy for CRC. Peritumoral injection of 0.5 to 1.0 ml of isosulfan blue dye was performed to demonstrate the sentinel node(s). All lymph nodes in the resection specimen were examined by routine hematoxylin and eosin staining. In addition, a focused examination of multiple sections of the sentinel nodes was performed using both hematoxylin and eosin and cytokeratin immunohistochemical analysis (CK-IHC). Overall, lymphatic mapping successfully demonstrated one to four sentinel lymph nodes in 97 (97%) of 100 patients. These sentinel nodes accurately reflected the status of the nodal basin in 92 (95%) of 97 patients. All five of the false negative cases occurred in T3/T4 tumors, and three of the five occurred during the first 30 cases in the experience. Unexpected lymphatic drainage was encountered in eight patients (8%) and altered the operative approach. Twenty-six patients were node positive by routine hematoxylin and eosin staining. Of the remaining 74 patients with hematoxylin and eosin-negative nodes, an additional 18 patients (24%) were upstaged by identification of occult nodal micrometastases that were missed on routine hematoxylin and eosin staining but detected on multiple sections (n = 5) or by CK-IHC (n = 13). The sentinel lymph nodes were the only positive nodes in 19 cases. Sentinel lymph node mapping may be performed in CRC with a high degree of success and accuracy. A focused pathologic examination of the sentinel node detects micrometastatic disease that is missed by conventional techniques in a significant proportion of patients with early CRC. Further studies are necessary to elucidate the clinical relevance of these micrometastases.

Original languageEnglish (US)
Pages (from-to)322-330
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume6
Issue number3
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Neoplasm Micrometastasis
Colorectal Neoplasms
Hematoxylin
Eosine Yellowish-(YS)
Staining and Labeling
Sentinel Lymph Node
Keratin-5
Colectomy
Keratins
Drainage
Coloring Agents
Lymph Nodes

Keywords

  • Colorectal carcinoma
  • Lymphatic mapping
  • Sentinel node
  • Staging

ASJC Scopus subject areas

  • Surgery

Cite this

One hundred consecutive cases of sentinel lymph node mapping in early colorectal carcinoma : Detection of missed micrometastases. / Wood, Thomas F.; Nora, Dean T.; Morton, Donald L.; Turner, Roderick R.; Rangel, Decio; Hutchinson, William; Bilchik, Anton J.; Zenilman, M.; Kelly, Keith A.

In: Journal of Gastrointestinal Surgery, Vol. 6, No. 3, 2002, p. 322-330.

Research output: Contribution to journalArticle

Wood, TF, Nora, DT, Morton, DL, Turner, RR, Rangel, D, Hutchinson, W, Bilchik, AJ, Zenilman, M & Kelly, KA 2002, 'One hundred consecutive cases of sentinel lymph node mapping in early colorectal carcinoma: Detection of missed micrometastases', Journal of Gastrointestinal Surgery, vol. 6, no. 3, pp. 322-330. https://doi.org/10.1016/S1091-255X(02)00013-6
Wood, Thomas F. ; Nora, Dean T. ; Morton, Donald L. ; Turner, Roderick R. ; Rangel, Decio ; Hutchinson, William ; Bilchik, Anton J. ; Zenilman, M. ; Kelly, Keith A. / One hundred consecutive cases of sentinel lymph node mapping in early colorectal carcinoma : Detection of missed micrometastases. In: Journal of Gastrointestinal Surgery. 2002 ; Vol. 6, No. 3. pp. 322-330.
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abstract = "Almost one third of patients with {"}node-negative{"} colorectal carcinoma (CRC) develop systemic disease. This implies that these patients have occult disease that is inadequately treated by surgery alone. We have coupled sentinel lymph node mapping and a focused pathologic examination to detect occult nodal micrometastases in CRC. Since 1996, sentinel lymph node mapping has been performed in 100 consecutive patients undergoing colectomy for CRC. Peritumoral injection of 0.5 to 1.0 ml of isosulfan blue dye was performed to demonstrate the sentinel node(s). All lymph nodes in the resection specimen were examined by routine hematoxylin and eosin staining. In addition, a focused examination of multiple sections of the sentinel nodes was performed using both hematoxylin and eosin and cytokeratin immunohistochemical analysis (CK-IHC). Overall, lymphatic mapping successfully demonstrated one to four sentinel lymph nodes in 97 (97{\%}) of 100 patients. These sentinel nodes accurately reflected the status of the nodal basin in 92 (95{\%}) of 97 patients. All five of the false negative cases occurred in T3/T4 tumors, and three of the five occurred during the first 30 cases in the experience. Unexpected lymphatic drainage was encountered in eight patients (8{\%}) and altered the operative approach. Twenty-six patients were node positive by routine hematoxylin and eosin staining. Of the remaining 74 patients with hematoxylin and eosin-negative nodes, an additional 18 patients (24{\%}) were upstaged by identification of occult nodal micrometastases that were missed on routine hematoxylin and eosin staining but detected on multiple sections (n = 5) or by CK-IHC (n = 13). The sentinel lymph nodes were the only positive nodes in 19 cases. Sentinel lymph node mapping may be performed in CRC with a high degree of success and accuracy. A focused pathologic examination of the sentinel node detects micrometastatic disease that is missed by conventional techniques in a significant proportion of patients with early CRC. Further studies are necessary to elucidate the clinical relevance of these micrometastases.",
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AU - Turner, Roderick R.

AU - Rangel, Decio

AU - Hutchinson, William

AU - Bilchik, Anton J.

AU - Zenilman, M.

AU - Kelly, Keith A.

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AB - Almost one third of patients with "node-negative" colorectal carcinoma (CRC) develop systemic disease. This implies that these patients have occult disease that is inadequately treated by surgery alone. We have coupled sentinel lymph node mapping and a focused pathologic examination to detect occult nodal micrometastases in CRC. Since 1996, sentinel lymph node mapping has been performed in 100 consecutive patients undergoing colectomy for CRC. Peritumoral injection of 0.5 to 1.0 ml of isosulfan blue dye was performed to demonstrate the sentinel node(s). All lymph nodes in the resection specimen were examined by routine hematoxylin and eosin staining. In addition, a focused examination of multiple sections of the sentinel nodes was performed using both hematoxylin and eosin and cytokeratin immunohistochemical analysis (CK-IHC). Overall, lymphatic mapping successfully demonstrated one to four sentinel lymph nodes in 97 (97%) of 100 patients. These sentinel nodes accurately reflected the status of the nodal basin in 92 (95%) of 97 patients. All five of the false negative cases occurred in T3/T4 tumors, and three of the five occurred during the first 30 cases in the experience. Unexpected lymphatic drainage was encountered in eight patients (8%) and altered the operative approach. Twenty-six patients were node positive by routine hematoxylin and eosin staining. Of the remaining 74 patients with hematoxylin and eosin-negative nodes, an additional 18 patients (24%) were upstaged by identification of occult nodal micrometastases that were missed on routine hematoxylin and eosin staining but detected on multiple sections (n = 5) or by CK-IHC (n = 13). The sentinel lymph nodes were the only positive nodes in 19 cases. Sentinel lymph node mapping may be performed in CRC with a high degree of success and accuracy. A focused pathologic examination of the sentinel node detects micrometastatic disease that is missed by conventional techniques in a significant proportion of patients with early CRC. Further studies are necessary to elucidate the clinical relevance of these micrometastases.

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