Lymphatic mapping and sentinel lymph node biopsy in epidermoid carcinoma of the anal canal.
OBJECTIVE
Although 15-25% of patients with anal cancer present with superficial inguinal lymph node metastases but the routine application of groin irradiation is controversial because of serious side effects. Inguinal sentinel lymph node biopsy (SLNB) can be used to select patients appropriately for inguinal radiation. The study evaluates the efficiency and clinical impact of SLNB.


METHODS
Forty patients with anal cancer underwent 1 ml Tc(99m)-Nanocolloid injection in four sites around the tumour. Patients with inguinal radio colloid enrichment were selected for sentinel lymph node biopsy (SLNB). Lymph node status was examined by haematoxylin and eosin (H&E) as well as immunohistochemistry-staining. All SLN-positive patients were scheduled for inguinal radiation; SLN-negative patients with T1 and early T2 tumours were not scheduled for inguinal radiation.


RESULTS
SLN were detected in 36/40 patients. Three common patterns of lymphatic drainage were observed: mesenterial, iliacal and inguinal. Twenty patients with inguinal SLN underwent SLN-biopsy. 6/20 patients were SLN-positive. In 10/20 patients SLNB altered the therapy plan--four patients with T1-tumours and positive SLN had additional groin irradiation, whereas 6 patients with small T2-tumors and tumour-free inguinal SLN did not undergo inguinal irradiation.


CONCLUSIONS
Inguinal sentinel node biopsy in anal cancer is efficient and could assist in the decision for inguinal radiation. The validity and safety of the proposed therapeutic algorithm has to be proven by a larger, prospective study.
Gretschel
S
S
Department of Surgery and Surgical Oncology, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany. Electronic address: stephan.gretschel@charite.de.
Warnick
P
P
Department of Surgery and Surgical Oncology, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany.
Bembenek
A
A
Department of Surgery and Surgical Oncology, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany.
Dresel
S
S
Division of Nuclear Medicine, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany.
Koswig
S
S
Division of Radiotherapy, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany.
String
A
A
Department of Surgery and Surgical Oncology, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany.
Hünerbein
M
M
Department of Surgery and Surgical Oncology, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany.
Schlag
P M
PM
Department of Surgery and Surgical Oncology, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany.
D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000556:secondary*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin