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Sentinel lymph node biopsy in colon cancer: A prospective multicenter trial

Item Type:Article
Title:Sentinel lymph node biopsy in colon cancer: A prospective multicenter trial
Creators Name:Bembenek, A.E. and Rosenberg, R. and Wagler, E. and Gretschel, S. and Sendler, A. and Siewert, J.R. and Naehrig, J. and Witzigmann, H. and Hauss, J. and Knorr, C. and Dimmler, A. and Groene, J. and Buhr, H.J. and Haier, J. and Herbst, H. and Tepel, J. and Siphos, B. and Kleespies, A. and Koenigsrainer, A. and Stoecklein, N.H. and Horstmann, O. and Gruetzmann, R. and Imdahl, A. and Svoboda, D. and Wittekind, C. and Schneider, W. and Wernecke, K.D. and Schlag, P.M.
Abstract:INTRODUCTION:: The clinical impact of sentinel lymph node biopsy (SLNB) in colon cancer is still controversial. The purpose of this prospective multicenter trial was to evaluate its clinical value to predict the nodal status and identify factors that influence these results. METHODS:: Colon cancer patients without prior colorectal surgery or irradiation were eligible. The sentinel lymph node (SLN) was identified intraoperatively by subserosal blue dye injection around the tumor. The SLN underwent step sections and immunohistochemistry (IHC), if classified free of metastases after routine hematoxylin and eosin examination. RESULTS:: At least one SLN (median, n = 2) was identified in 268 of 315 enrolled patients (detection rate, 85%). Center experience, lymphovascular invasion, body mass index (BMI), and learning curve were positively associated with the detection rate. The false-negative rate to identify pN+ patients by SLNB was 46% (38 of 82). BMI showed a significant association to the false-negative rate (P < 0.0001), the number of tumor-involved lymph nodes was inversely associated. If only slim patients (BMI </=24) were investigated in experienced centers (>22 patients enrolled), the sensitivity increased to 88% (14 of 16). Moreover, 21% (30 of 141) of the patients, classified as pN0 by routine histopathology, revealed micrometastases or isolated tumor cells (MM/ITC) in the SLN. CONCLUSIONS:: The contribution of SLNB to conventional nodal staging of colon cancer patients is still unspecified. Technical problems have to be resolved before a definite conclusion can be drawn in this regard. However, SLNB identifies about one fourth of stage II patients to reveal MM/ITC in lymph nodes. Further studies must clarify the clinical impact of these findings in terms of prognosis and the indication of adjuvant therapy.
Keywords:Contrast Media, Drug Dose-Response Relationship, Gadolinium DTPA, Image Enhancement, Computer-Assisted Image Processing, Linear Models, Magnetic Resonance Angiography, Myocardium
Source:Annals of Surgery
ISSN:0003-4932
Publisher:Lippincott Williams & Wilkins (U.S.A.)
Volume:245
Number:6
Page Range:858-863
Date:June 2007
Official Publication:https://doi.org/10.1097/01.sla.0000250428.46656.7e
PubMed:View item in PubMed

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