Sentinel lymph node biopsy in colon cancer: a prospective multicenter trial.
BACKGROUND
The clinical impact of sentinel lymph node biopsy (SLNB) in colon cancer is still controversial. The purpose of this prospective multicenter trial was to evaluate its clinical value to predict the nodal status and identify factors that influence these results.


METHODS
Colon cancer patients without prior colorectal surgery or irradiation were eligible. The sentinel lymph node (SLN) was identified intraoperatively by subserosal blue dye injection around the tumor. The SLN underwent step sections and immunohistochemistry (IHC), if classified free of metastases after routine hematoxylin and eosin examination.


RESULTS
At least one SLN (median, n = 2) was identified in 268 of 315 enrolled patients (detection rate, 85%). Center experience, lymphovascular invasion, body mass index (BMI), and learning curve were positively associated with the detection rate. The false-negative rate to identify pN+ patients by SLNB was 46% (38 of 82). BMI showed a significant association to the false-negative rate (P < 0.0001), the number of tumor-involved lymph nodes was inversely associated. If only slim patients (BMI < or =24) were investigated in experienced centers (>22 patients enrolled), the sensitivity increased to 88% (14 of 16). Moreover, 21% (30 of 141) of the patients, classified as pN0 by routine histopathology, revealed micrometastases or isolated tumor cells (MM/ITC) in the SLN.


CONCLUSIONS
The contribution of SLNB to conventional nodal staging of colon cancer patients is still unspecified. Technical problems have to be resolved before a definite conclusion can be drawn in this regard. However, SLNB identifies about one fourth of stage II patients to reveal MM/ITC in lymph nodes. Further studies must clarify the clinical impact of these findings in terms of prognosis and the indication of adjuvant therapy.
Bembenek
Andreas E
AE
Department of Surgery and Surgical Oncology, Robert-Rössle-Klinik, Charité University Medicine Berlin, Campus Buch at HELIOS-Klinikum Berlin, Lindenberger Weg 80, 13125 Berlin, Germany.
Rosenberg
Robert
R
Wagler
Elke
E
Gretschel
Stephan
S
Sendler
Andreas
A
Siewert
Joerg-Ruediger
JR
Nährig
Jörg
J
Witzigmann
Helmut
H
Hauss
Johann
J
Knorr
Christian
C
Dimmler
Arno
A
Gröne
Jörn
J
Buhr
Heinz-Johannes
HJ
Haier
Jörg
J
Herbst
Hermann
H
Tepel
Juergen
J
Siphos
Bence
B
Kleespies
Axel
A
Koenigsrainer
Alfred
A
Stoecklein
Nikolas H
NH
Horstmann
Olaf
O
Grützmann
Robert
R
Imdahl
Andreas
A
Svoboda
Daniel
D
Wittekind
Christian
C
Schneider
Wolfgang
W
Wernecke
Klaus-Dieter
KD
Schlag
Peter M
PM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy
D004396:Coloring Agents; D012394:Rosaniline Dyes; C008769:sulfan blue