title: Sentinel node biopsy for the individualization of surgical strategy for cure of early-stage colon cancer.
abstract: BACKGROUND
  The requirement for nodal analysis currently confounds the oncological propriety of focused purely endoscopic resection for early-stage colon cancer and complicates the evolution of innovative alternatives such as natural orifice transluminal endoscopic surgery (NOTES) and its hybrids. Adjunctive sentinel node biopsy (SNB) deserves consideration as a means of addressing this shortfall.
  
  
  METHODS
  Data from two prospectively maintained databases established for multicentric studies of SNB in colon cancer that employed similar methodologies were pooled to establish technique potency selectively in T1/T2 disease (both overall and under optimized conditions) and to project potential clinical impact.
  
  
  RESULTS
  Of 891 patients with T1-4, M0 intraperitoneal colon cancer, 225 had T1/T2 disease. Sentinel nodes were either not found or were falsely negative in 18 patients with T1/T2 cancers (8%) as compared with 17% (112/646) in those with T3/T4 disease (P = 0.001). Negative predictive value (NPV) in the former exceeded 95%, while sensitivity [including immunohistochemistry (IHC)] was 81%. In the 193 patients with T1/T2 disease recruited from those centers contributing >22 patients, sensitivity was 89% and NPV 97%. Thus, in this cohort, SNB could have correctly prompted localized resection (obviating en bloc mesenteric dissection) in 75% (144) of patients, including 59 with T1 lesions potentially amenable to intraluminal resection alone as their definitive treatment. Forty-four patients (23.4%) would still have conventional resection, leaving three patients (1.6% overall) understaged (11% false-negative rate).
  
  
  CONCLUSIONS
  These findings support the further investigation of SNB as oncological augment for localized resective techniques. Specific prospective study should pursue this goal.
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland. cahillra@gmail.com
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Cahill
authors.forename: Andreas
authors.initials: A
authors.lastname: Bembenek
authors.forename: Saad
authors.initials: S
authors.lastname: Sirop
authors.forename: Deirdre F
authors.initials: DF
authors.lastname: Waterhouse
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schneider
authors.forename: Joel
authors.initials: J
authors.lastname: Leroy
authors.forename: David
authors.initials: D
authors.lastname: Wiese
authors.forename: Thomas
authors.initials: T
authors.lastname: Beutler
authors.forename: Anton
authors.initials: A
authors.lastname: Bilchik
authors.forename: Sukamal
authors.initials: S
authors.lastname: Saha
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schlag
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy