Sentinel node staging of resectable colon cancer: results of a multicenter study.
OBJECTIVE
Sentinel lymph node (LN) sampling, a technique widely used to manage breast cancer and melanoma, seeks to select LNs that accurately predict regional node status and can be extensively examined to identify nodal metastatic disease not detected by standard histopathological staging. For patients with resectable colon cancer, improved identification of LN disease would significantly advance patient care by identifying patients likely to benefit from adjuvant therapy. This study, conducted by 25 surgeons at 13 institutions, examined whether sentinel node (SN) sampling accurately predicted LN status for patients with resectable colon cancer.


METHODS
SN sampling involved peritumor injection of 1% isosulfan blue, followed by identification of all LN visualized within 10 minutes. SN sampling was performed on 79 of 91 patients enrolled, followed by multilevel sectioning (MLS) of the nodes and examination by a single study pathologist.


RESULTS
By standard histopathology, 7 patients had primary disease that was either benign or not colon cancer and were therefore excluded from further studies. Of 72 colon cancer cases studied, 48 (66%) were node-negative and 24 (33%) contained nodal metastases. SNs were successfully located in 66 cases (92%), with an average of 2.1 nodes per patient. SNs were negative in 14 of 24 node-positive cases (58%). MLS revealed tumor in a SN in 1 of these cases, bringing the false-negative rate of SN examination to 54%.


CONCLUSIONS
This multi-institutional study found that for patients with node-positive colon cancer, SN examination with MLS failed to predict nodal status in 54% of cases. We conclude that SN sampling with MLS, used alone, is unlikely to improve risk stratification for resectable colon cancer.
Bertagnolli
Monica
M
Brigham and Women's Hospital, Boston, MA, USA. mbertagnolli@partners.org
Miedema
Brent
B
Redston
Mark
M
Dowell
Jeannette
J
Niedzwiecki
Donna
D
Fleshman
James
J
Bem
Jiri
J
Mayer
Robert
R
Zinner
Michael
M
Compton
Carolyn
C
D000368:Aged; D015331:Cohort Studies; D003082:Colectomy; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D004396:Coloring Agents; D005188:False Negative Reactions; D005240:Feasibility Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018570:Risk Assessment; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D012811:Sigmoid Neoplasms / Q000473:pathology / Q000601:surgery; D016037:Single-Blind Method
D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue