title: Identification of lymph node metastases in recurrent colorectal cancer.
abstract: Lymph node metastases are an important prognostic prediction factor in patients with recurrent colorectal cancer, particularly those with liver metastasis. Fifty-six patients with recurrent colorectal cancer were operated by us using the RIGS (radioimmunoguided surgery) technology. Patients were injected with 1 mg monoclonal antibody (MoAb) CC49 labeled with 2 mCi 125I. In surgery, traditional exploration was followed by survey with a gamma-detecting probe. Sixty of 151 patients enrolled in the Neo2-14 Phase III study for recurrent colorectal cancer were diagnosed with liver metastases based on preoperative CT. In 17/56 patients (30%), RIGS identified at least one tumor site confirmed by pathology (H&E). This resulted in 16 major changes in surgical plan. RIGS performance varied between lymphatic and non-lymphatic tissue, with positive predictive value (PPV) of 100% and negative predictive value (NPV) of 94% for non-lymphoid tissue, compared to PPV of 46.5% and NPV of 100% for the lymphoid tissue. Thirty-five out of 60 patients were considered resectable after traditional evaluation. RIGS identified occult tumor in 10 of these patients (28.5%). 7/10 occult patients expired (70%), while only 7/25 of the non-occult patients expired (28%) (P = 0.046). In localizing patients, no RIGS activity in lymph nodes signifies no tumor, while H&E confirmation is needed for decisions based on RIGS activity in the lymph nodes. RIGS provides important staging information, identifying patients for whom surgery may be done with curative intent.
authors.affiliation: Department of Surgery A, Tel-Aviv Sourasky Medical Center, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Schneebaum
authors.forename: A
authors.initials: A
authors.lastname: Troitsa
authors.forename: S
authors.initials: S
authors.lastname: Avital
authors.forename: R
authors.initials: R
authors.lastname: Haddad
authors.forename: H
authors.initials: H
authors.lastname: Kashtan
authors.forename: G
authors.initials: G
authors.lastname: Gitstein
authors.forename: M
authors.initials: M
authors.lastname: Baratz
authors.forename: E
authors.initials: E
authors.lastname: Brazovsky
authors.forename: J
authors.initials: J
authors.lastname: Papo
authors.forename: Y
authors.initials: Y
authors.lastname: Skornick
mesh_terms: D000230:Adenocarcinoma / Q000737:chemistry / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D014408:Biomarkers, Tumor / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis; D015179:Colorectal Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology*; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D016719:Radioimmunodetection / Q000295:instrumentation / Q000379:methods*; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen