title: Sentinel lymph node biopsy in colon cancer: a prospective multicenter trial.
abstract: 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.
authors.affiliation: 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.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Bembenek
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenberg
authors.forename: Elke
authors.initials: E
authors.lastname: Wagler
authors.forename: Stephan
authors.initials: S
authors.lastname: Gretschel
authors.forename: Andreas
authors.initials: A
authors.lastname: Sendler
authors.forename: Joerg-Ruediger
authors.initials: JR
authors.lastname: Siewert
authors.forename: Jörg
authors.initials: J
authors.lastname: Nährig
authors.forename: Helmut
authors.initials: H
authors.lastname: Witzigmann
authors.forename: Johann
authors.initials: J
authors.lastname: Hauss
authors.forename: Christian
authors.initials: C
authors.lastname: Knorr
authors.forename: Arno
authors.initials: A
authors.lastname: Dimmler
authors.forename: Jörn
authors.initials: J
authors.lastname: Gröne
authors.forename: Heinz-Johannes
authors.initials: HJ
authors.lastname: Buhr
authors.forename: Jörg
authors.initials: J
authors.lastname: Haier
authors.forename: Hermann
authors.initials: H
authors.lastname: Herbst
authors.forename: Juergen
authors.initials: J
authors.lastname: Tepel
authors.forename: Bence
authors.initials: B
authors.lastname: Siphos
authors.forename: Axel
authors.initials: A
authors.lastname: Kleespies
authors.forename: Alfred
authors.initials: A
authors.lastname: Koenigsrainer
authors.forename: Nikolas H
authors.initials: NH
authors.lastname: Stoecklein
authors.forename: Olaf
authors.initials: O
authors.lastname: Horstmann
authors.forename: Robert
authors.initials: R
authors.lastname: Grützmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Imdahl
authors.forename: Daniel
authors.initials: D
authors.lastname: Svoboda
authors.forename: Christian
authors.initials: C
authors.lastname: Wittekind
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schneider
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schlag
mesh_terms: 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
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C008769:sulfan blue