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Vol. 33. Num. 1.January - March 2013
Pages 1-48
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Vol. 33. Num. 1.January - March 2013
Pages 1-48
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
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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
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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
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