Sentinel node staging in colon carcinoma: value of sentinel lymph node biopsy with radiocolloid and blue staining.
BACKGROUND
Nodal staging accuracy is important in the prognosis and selection of patients for chemotherapy. This prospective study aims to assess the feasibility and accuracy of the sentinel lymph node procedure (SNP) using radiocolloid and blue dye in colon carcinoma.


METHODS
In 56 patients, lymphatic mapping was accomplished by means of intraoperatively injecting patent blue and nanocoll subserosally around the tumour. Sentinel nodes (SNs) were harvested ex-vivo. Nodes were stained with H&E. If lymph nodes were interpreted as negative for metastatic tumour, serial sectioning and immunohistochemical staining were performed.


RESULTS
At least one SN was detected in 49 of 53 patients (92.5%). Three patients were excluded because of preoperatively detected metastases. Overall, 121 SN were harvested with a mean of 2.2 SN/patients. Eighteen patients had tumour positive nodes. In four patients, pathological nodes were palpable during operation and were excluded. The SN was histologically negative in 2 of 14 patients with positive nodes (false-negative rate 14.3%). In 5 of 14 patients with positive nodes, the SN was the exclusive site of regional nodal metastasis. Four patients were upstaged by immunohistochemical staining (28.6%). The negative predictive value was 93.9% and the overall accuracy 95.6%. Scintigraphy was done in 17 patients. In three patients the SN was detected only by this modality.


CONCLUSIONS
The SN biopsy with the combined technique proved a feasible technique with a steep learning curve. It can change the initial staging from stage II to stage III colon carcinoma. Scintigraphy can improve the success rate of the technique.
Terwisscha Van Scheltinga
S E J
SE
Department of Surgical Oncology, Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands.
Den Boer
F C
FC
Pijpers
R
R
Meyer
G A
GA
Engel
A F
AF
Silvis
R
R
Meijer
S
S
van der Sijp
J R M
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D004396:Coloring Agents; D004801:Eosine Yellowish-(YS); D005188:False Negative Reactions; D005240:Feasibility Studies; D005260:Female; D006416:Hematoxylin; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D013194:Staining and Labeling; D013668:Technetium Tc 99m Aggregated Albumin
D004396:Coloring Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin