title: A prospective evaluation of radiocolloid and immunohistochemical staining in colon carcinoma lymphatic mapping.
abstract: BACKGROUND
  Although the utility of lymphatic mapping (LM) and sentinel lymph node (SLN) biopsy in patients with melanoma and breast carcinoma has been well documented, this same is not true for patients with colon carcinoma. The authors previously reported a high false-negative rate for SLN biopsy in patients with colon carcinoma using isosulfan blue dye alone. The objective of the current study was to determine whether radiocolloid would increase the sensitivity of LM/SLN biopsy in patients with colon carcinoma.
  
  
  METHODS
  The authors performed LM on 57 patients with colon carcinoma using both isosulfan blue dye and radiocolloid. The SLN(s) were identified by either their blue color or by increased radioactivity. The SLNs then underwent both routine histologic sectioning and immunohistochemical (IHC) staining for cytokeratins.
  
  
  RESULTS
  An SLN was identified in 56 patients (98%). Radiocolloid was able to identify only 1 additional positive SLN (9%). Overall, it was found that the disease had metastasized to the lymph nodes in 22 patients, even though there was no evidence of disease in the SLN(s) in 11 of those 22 patients on routine histologic sectioning (false-negative rate, 50%; sensitivity, 50%). In five patients, IHC of the SLN was the only indicator of metastatic disease. The inclusion of IHC-positive SLNs in these calculations would decrease the false-negative rate to 17% and would increase the sensitivity of SLN biopsy to 83%.
  
  
  CONCLUSIONS
  In the current study, the addition of radiocolloid did not increase the sensitivity of detection of positive SLN(s) compared with the use of isosulfan blue dye alone. IHC of the SLN potentially may increase the sensitivity of LM and reduce the false-negative rate. However, the long-term prognostic significance of IHC in patients with colon carcinoma remains controversial.
authors.affiliation: Department of General Surgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Lane C
authors.initials: LC
authors.lastname: Patten
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Miguel
authors.initials: M
authors.lastname: Rodriguez-Bigas
authors.forename: Paul
authors.initials: P
authors.lastname: Mansfield
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Delpassand
authors.forename: Karen R
authors.initials: KR
authors.lastname: Cleary
authors.forename: Shawn P
authors.initials: SP
authors.lastname: Fagan
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000556:secondary; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007633:Keratins / Q000378:metabolism; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid; D007633:Keratins