Journal Information
Vol. 33. Num. 1.
Pages 1-48 (January - March 2013)
Share
Share
Download PDF
More article options
Vol. 33. Num. 1.
Pages 1-48 (January - March 2013)
Original article
DOI: 10.1016/j.jcol.2013.08.001
Open Access
Ex vivo sentinel lymph node investigation in colorectal cancer
Pesquisa do linfonodo-sentinela ex vivo no câncer colorretal
Visits
2868
Antônio Hilário Alves Freitasa,b,
Corresponding author
hilariofreitas@ig.com.br

Corresponding author.
, Alberto Julius Alves Wainsteinb, Tarcizo Afonso Nunesc
a Brazilian Society of Coloproctology, Rio de Janeiro, RJ, Brazil
b Trymed Clinical Research, Belo Horizonte, MG, Brazil
c Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
This item has received
2868
Visits

Under a Creative Commons license
Article information
Abstract
Introduction

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.

Keywords:
Sentinel lymph node
Ex vivo
Colorectal cancer
Metastases
Resumo
Introdução

No Brasil, a cada ano são diagnosticados cerca de 26.000 casos de câncer colorre- tal. Pacientes com estadiamento considerado inicial, sem linfonodo metastático, evoluem com recorrência ou recidiva do tumor em até um quarto dos casos, por provável subesta- diamento. Objetivo: pesquisar sobre linfonodo-sentinela ex vivo em pacientes com adeno- carcinoma colorretal.

Objetivo

Foram estudados 37 pacientes, submetidos à cirurgia oncológica com ressecção caráter curativo. O marcador de linfonodos utilizado foi o corante azul patente, injetado na submucosa peritumoral da peça cirúrgica aberta imediatamente depois de sua retirada da cavidade abdominal.

Pacientes e métodos

A identificação ex vivo de linfonodo-sentinela com o marcador ocorreu em 13 (35,1%) pacientes. A sensibilidade do método foi de 40% e o falso negativo de 60%. O exame histológico pormenorizado dos linfonodos-sentinela com multissecção e imu- noistoquímica diagnosticou metástase em um (4,3%) indivíduo, sendo considerado ultra--estadiamento.

Resultados

A identificação de linfonodo-sentinela ex vivo apresenta benefícios questioná- veis, e piores resultados quando são incluídos pacientes com câncer de reto. Foi possível reestadiamento de um paciente depois da realização de multissecção e imunoistoquímica de linfonodos-sentinela, mas mais trabalhos são necessários para estabelecer a importân- cia das micrometástases em pacientes com câncer colorretal.

Palavras-chave:
Linfonodo-sentinela
Ex vivo
Câncer colorretal
Metástases
Full text is only aviable in PDF
References
[1]
World Health Organization (WHO), 2008. Available at: http://www.who.int/cancer.
[2]
D.L. Morton, D.R. Wen, J.H. Wong, J.S. Economou, L.A. Cagle, F.K. Storm, et al.
Technical details of intraoperative lymphatic mapping for early stage melanoma.
Arch Surg, 127 (1992), pp. 392-399
[3]
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.
[4]
N. Wolmark, H. Rockette, E.P. Mamounas.
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 (1996), pp. 205
[5]
A.J. Bilchick, D.T. Nora.
Lymphatic mapping of nodal micrometastasis in colon cancer: putting the cart before the horse?.
Ann Surg Oncol, 9 (2002), pp. 529-531
[6]
S. Bertoglio, S. Sandrucci, P. Percivale, M. Goss, M. Gipponi, L. Moresco, et al.
Prognostic value of sentinel lymph node biopsy in the pathologic staging of colorectal cancer Patients.
J Surg Oncol, 85 (2004), pp. 166-170
[7]
S. Saha, R. Seghal, M. Patel, K. Doan, A. Dan, A. Bilchick, et al.
A multicenter trial of sentinel lymph node mapping in colorectal cancer: Prognostic Implications for nodal staging and recurrence.
Am J Surg, 191 (2006), pp. 305-310
[8]
Greene FL, Balch CM, Fleming ID (eds.). AJCC Cancer Staging Handbook: TNM classification of Malignant Tumors. New York: Springer-Verlag, 2009. p. 129.
[9]
L.R. Braithwaite.
Flow of lymph from the ileocecal angle.
Br J Surg, 11 (1923), pp. 7
[10]
J.H. Wong, S. Steineman, C. Calderia, J. Bowles, T. Namiki.
Ex vivo sentinel node mapping in carcinoma of the colon and rectum.
Ann Surg, 233 (2001), pp. 515-521
[11]
S.W. Bell, N. Mourra, J.F. Fléjou, R. Parc.
Tiret E.Ex vivo sentinel lymph node mapping in colorectal cancer.
Dis Colon Rectum, 48 (2005), pp. 74-79
[12]
S. Demirbas, M. Ince, H. Baloglu, T. Celenk.
Should sentinel lymph node mapping for colorectal cancer be performed?.
Turk J Gastroenterol, 5 (2004), pp. 39-44
[13]
J. Smith, H. Hwang, K.W. Wiseman, D. Filipenko, P.T. Phang.
Ex vivo sentinel lymph node mapping in colon cancer: Improving the accuracy of pathologic staging?.
Am J Surg, 191 (2006), pp. 665-668
[14]
O. Sommariva, P.M. Donisi, B. Gnocato, R. Vianello, V.S. Pansa, G. Zaninotto.
Factors Affecting false-negative rates on ex vivo sentinel lymph node mapping in colorectal cancer.
Eur J Surg Oncol, 36 (2010), pp. 130-134
[15]
E.S. van der Zaag, C.J. Buskens, N. Kooij, H. Akol, H.M. Peters, W.H. Bouma, et al.
Improving staging accuracy in colon and rectal cancer by sentinel lymph node mapping: a comparative study.
Eur J Surg Oncol, 35 (2009), pp. 1065-1070
[16]
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.
[17]
A.H.A. Freitas, T.A. Nunes, A.J.A. Wainstein, A.A. Barroso, O.P. Ricardo Filho, M.A. Dias.
Search sentinel lymph node in patients with colon cancer.
Rev Bras Coloproct, 28 (2008), pp. 170-177
[18]
J.H. Wong, D.S. Johnson, P. Namike, N.P. Tauchi.
Validation of ex vivo lymphatic mapping in Hematoxylin-eosin node- negative carcinoma of the colon and rectum.
Ann Surg Oncol, 11 (2004), pp. 772-777
[19]
A.B. Benson, D. Schrag, M.R. Somerfield, A.M. Cohen, A.T. Figueredo, P.J. Flynn, et al.
American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer.
J Clin Oncol, 22 (2004), pp. 3408-3419
[20]
B.M. Rossi, P.S. Bepu Jr., F.O. Ferreira, E.M.M. Santos, Aguiar Jr., W.T. Nakagawa, et al.
Number of dissected lymph nodes in colorectal cancer Patients Submitted to radical surgery: the quality of oncology treatment.
Applied Cancer Research, 26 (2006), pp. 27-33
[21]
C.A. Quadros, A. Lopes, I. Araujo.
Suggestion of optimal patient characteristics for sentinal lymph node mapping in colorectal adenocarcinoma.
Arq Gastroentelol, 47 (2010), pp. 344-347
[22]
G. Dess Guetz, B. Uzzan, P. Nicolas, M. Cucherat, P. Mestier, J.F. Morere, et al.
Is sentinel lymph node mapping in colorectal cancer a future Prognostic factor?. A meta-analysis.
World J Surg, 31 (2007), pp. 1304-1312
[23]
O. Tiffet, D. Kaczmarek, M.R. Chambonierre, T. Guillan, S. Baccot, N. Prevot, et al.
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 (2007), pp. 962-970
[24]
J.J.A. Joosten, J.L.A. Strobbe, C.A.P. Wauters, M. Pruszczynski, T. Wobbes, T.J.M. Ruers.
Intraoperative lymphatic mapping and the sentinel node concept in colorectal carcinoma.
[25]
F.S. Doekhie, K.C.M.J. Peeters, P.J.K. Kuppen, W.E. Mesker, H.J. Tanke, H. Morreau, et al.
The feasibility and reliability of sentinel node mapping in colorectal cancer.
Eur J Oncol Soc, 31 (2005), pp. 854-862
[26]
J.J. Tuech, P. Pessaux, N. Regenet, R. Bergamaschi, A. Colson.
Sentinel lymph node mapping in colon cancer.
Surg Endosc, 18 (2004), pp. 1721-1729
[27]
Y. Kitagawa, M. Watanabe, H. Hasegawa, S. Yamamoto, H. Fujii, K. Yamamoto, et al.
Sentinel node mapping for colorectal cancer with radioactive tracer.
Dis Colon Rectum, 45 (2002), pp. 1476-1480
[28]
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.
[29]
L.N. Steenbergen, G. van Lijnschoten, H.J. Rutten, V.E. Lemmens, J.W. Coebergh.
Improving lymph node detection in colon câncer in community hospitals and their pathology department in southern Netherlands.
Eur J Surg Oncol, 36 (2010), pp. 135-140
[30]
F. Paraf, J.C. Sabourin.
Optimal lymph node number and occult lymph node metastases in colorectal cancer: the pathologists view.
Gastroenterol Clin Biol, 24 (2000), pp. 423-459
[31]
J. Tschmelitsch, D.S. Klimstra, A.M. Cohen.
Lymph node micrometastases not predict relapse in stage II colon cancer.
Ann Surg Oncol, 7 (2000), pp. 601-608
[32]
A.M. Cohen, S. Tremiterra.
Candeh F. Adjuvant therapy for colorectal cancer.
Curr Prob Cancer, 22 (1998), pp. 5-65
[33]
C. Codignola, F. Zorzi, A. Zaniboni, S. Mutti, A. Rizzi, E. Padolecchia, et al.
Is there any role for sentinel node mapping in colorectal cancer staging? Personal experience and review of the literature.
Jpn J Clin Oncol, 35 (2005), pp. 645-650
[34]
A.E. Bembenek, U. Schineider, S. Gretschel, J. Fisher.
Detection of lymph node micrometastases and isolated tumor cells in sentinel and nonsentinel lymph nodes of colon cancer patients.
World J Surg, 29 (2005), pp. 1172-1175
[35]
Y. Bendavid, M. Latulippe, R.J. Younan, Y.E. Leclerc, S. Dube, F. Heyen, I. Phase, et al.
study on sentinel lymph node mapping in colon cancer: a preliminary report.
J Surg Oncol, 79 (2002), pp. 81-84
Copyright © 2013. Sociedade Brasileira de Coloproctologia
Idiomas
Journal of Coloproctology

Subscribe to our newsletter

Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.