Sentinel node mapping does not improve staging of lymph node metastasis in colonic cancer.
OBJECTIVE
This study was designed to evaluate the reliability of the sentinel node concept in colonic cancer.


METHODS
Patent blue was used as tracer. The four blue nodes closest to the tumor were defined as the sentinel node(s) by the pathologist. All nodes were examined by routine microscopy (hematoxylin-eosin staining). If no metastases were detected, all lymph nodes were examined immunohistochemically with antibody to cytokeratin.


RESULTS
Two hundred colon specimens were examined. Sentinel node(s) were identified in 93 percent. Sixty contained metastases in hematoxylin-eosin sections. In 32 these were found in sentinel nodes (sensitivity 53 percent). Twenty-eight patients had metastases in nonsentinel nodes only, giving a false-negative rate of 47 percent. Immunostaining revealed 39 (30 percent) micrometastases or submicrometastases in 131 TNM Stages I and II patients, and in 17 of these patients metastases were found in nonsentinel nodes only (false-negative rate 44 percent).


CONCLUSIONS
Sentinel lymph node mapping shows low sensitivity for detection of ordinary metastases, micrometastases, and submicrometastases. If only the sentinel nodes had been examined, approximately half of the metastases would have been lost after routine staining, as well as half of the micrometastases and submicrometastases when immunohistochemical examination was added.
Faerden
Arne E
AE
Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Oslo, Norway. arneferden@tele2.no
Sjo
Ole H
OH
Sjo
Ole
O
Andersen
Solveig Norheim
SN
Hauglann
Beate
B
Nazir
Naimy
N
Gravdehaug
Berit
B
Gravedaug
Berit
B
Moberg
Ingvild
I
Svinland
Aud
A
Nesbakken
Arild
A
Bakka
Arne
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy