Comparison of ex vivo and in vivo injection of blue dye in sentinel lymph node mapping for colorectal cancer.
BACKGROUND
The technique of sentinel lymph node (SLN) mapping in patients with colorectal cancer varies between reports, and the optimal method has not been established. The purpose of this study was to determine the optimal injection technique for SLN mapping.


METHODS
Sixty-nine consecutive patients who underwent curative surgery for colorectal cancer were enrolled. The SLNs was identified intraoperatively by subserosal blue dye injection (in vivo) or by submucosal injection after standard colectomy (ex vivo). If negative by conventional hematoxylin and eosin staining analysis, all lymph nodes, SLNs and non-SLNs, were subjected to further analysis by multi-level section and immunohistochemical examination.


RESULTS
The in vivo and ex vivo injected groups were similar in demographic character, tumor size, and histological grade. The mean number of SLNs identified was 2.3 in the in vivo group and 2.6 in the ex vivo group (p = 0.192). The detection rate of SLNs by blue dye injection was somewhat higher in the ex vivo group than in the in vivo group: 90.6 vs. 81.1% (p = 0.219). The false-negative rate was 23.5% for the in vivo group and 13.3% for the ex vivo group (p = 0.392). The upstaging rate, which was 18.5% overall, was similar in both groups (p = 0.538).


CONCLUSIONS
These findings suggest that ex vivo blue dye injection is an effective alternative to in vivo injection for identifying SLNs in patients with colorectal cancer. Because of its simplicity and applicability in routine clinical settings, further investigation of the ex vivo mapping technique is warranted.
Park
Jun Seok
JS
Department of Surgery, Chung-Ang University, College of Medicine, 224-1 Heukseok_Dong, Dongjak-Gu, Seoul 156-755, South Korea.
Chang
In Taik
IT
Park
Sung Jun
SJ
Kim
Beom Gyu
BG
Choi
Yoo Shin
YS
Cha
Seong Jae
SJ
Park
Eon Sub
ES
Kwon
Gui Young
GY
D015179:Colorectal Neoplasms / Q000473:pathology*; D004396:Coloring Agents / Q000008:administration & dosage*; D004791:Enzyme Inhibitors; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008751:Methylene Blue / Q000008:administration & dosage*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome
D004396:Coloring Agents; D004791:Enzyme Inhibitors; D008751:Methylene Blue