Immunoguided lymph node dissection in colorectal cancer: a new challenge?
Knowledge of lymphatic involvement in patients with colorectal cancer is important in surgery and in the postoperative decision-making process. Fifty-eight patients with recurrent colorectal cancer underwent operation with the RIGS/(Radioimmunoguided Surgery) technology. Preoperatively, patients were injected with 1 mg monoclonal antibody (MoAb) CC49 (anti-TAG-72-tumor-associated glycoprotein) labeled with 2 mCi of iodine 125. Traditional surgical exploration was followed by survey with a gamma-detecting probe. Localization of MoAb on tumor was noted in 54/58 patients (93%). Traditional exploration identified 117 suspected tumor sites. With RIGS, 177 suspected tumor sites were detected. In 17 of the 58 patients (27.5%), at least one occult tumor site identified by RIGS was confirmed by pathology with hematoxylin & eosin (H & E) staining. This finding resulted in 16 major changes in surgical plan. RIGS performance varied between lymphatic and non-lymphatic tissue, with a positive predictive value (PPV) of 95.6% and negative predictive value (NPV) of 90% in non-lymphoid tissue compared to PPV of 40% and NPV of 100% in lymphoid tissue. In patients with tumors that localize, no RIGS activity in lymph nodes signifies no tumor, while decisions based on RIGS activity in lymph nodes requires H & E confirmation. Using this guideline, additional information acquired by RIGS can help the surgeon in making an informed decision during surgery and in planning postoperative therapy.
Schneebaum
S
S
Radioguided Surgery Unit, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv Sourasky Medical Center, Israel. rgssch@tasmc.health.gov.il
Troitsa
A
A
Haddad
R
R
Avital
S
S
Kashtan
H
H
Baratz
M
M
Brazovsky
E
E
Papo
J
J
Skornick
Y
Y
D000911:Antibodies, Monoclonal; D000912:Antibodies, Neoplasm; D017326:Clinical Trials, Phase III as Topic; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D007457:Iodine Radioisotopes; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D016719:Radioimmunodetection; D014057:Tomography, X-Ray Computed
D000911:Antibodies, Monoclonal; D000912:Antibodies, Neoplasm; C091202:B72.3 antibody; D007457:Iodine Radioisotopes