Endoscopic tattooing of early colon carcinoma enhances detection of lymph nodes most prone to harbor tumor burden.
Colorectal cancer (CRC) screening programs result in the detection of early-stage asymptomatic carcinomas suitable to be surgically cured. Lymph nodes (LN) from early CRC are usually small and may be difficult to collect. Still, at least 12 LNs should be analyzed from colectomies, to ensure a reliable pN0 stage. Presurgical endoscopic tattooing improves LN procurement. In addition, molecular detection of occult LN tumor burden in histologically pN0 CRC patients is associated with a decreased survival rate. We aimed to study the impact of presurgical endoscopic tattooing on the molecular detection of LN tumor burden in early colon neoplasms.



A prospective cohort study from a CRC screening-based population was performed at a tertiary academic hospital. LNs from colectomies with and without preoperative endoscopic tattooing were assessed by two methods, hematoxylin and eosin (HE), and RT-LAMP, to detect tumor cytokeratin 19 (CK19) mRNA. We compared the amount of tumor burden and LN yields from tattooed and non-tattooed specimens.



HE and RT-LAMP analyses of 936 LNs were performed from 71 colectomies containing early carcinomas and endoscopically unresectable adenomas (8 pT0, 17 pTis, 27 pT1, 19 pT2); 47 out of 71 (66.2 %) were tattooed. Molecular positivity correlated with the presence of tattoo in LN [p < 0.001; OR 3.1 (95 % CI 1.7-5.5)]. A significantly higher number of LNs were obtained in tattooed specimens (median 17 LN vs. 14.5 LN; p = 0.019).



Endoscopic tattooing enables the analysis of those LNs most prone to harbor tumor cells and improves the number of LN harvested.
Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain.
Iban
I
Aldecoa
Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain.
Carla
C
Montironi
Bioinformatics Unit, CIBERehd, Barcelona, Spain.
Nuria
N
Planell
Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain.
Maria
M
Pellise
Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain.
Gloria
G
Fernandez-Esparrach
Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain.
Angels
A
Gines
Surgery Department, Hospital Clinic, Barcelona, Spain.
Salvadora
S
Delgado
Surgery Department, Hospital Clinic, Barcelona, Spain.
Dulce
D
Momblan
Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain.
Leticia
L
Moreira
Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain.
Maria
M
Lopez-Ceron
Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain.
Natalia
N
Rakislova
Anestesiology Department, ICMDiM, Hospital Clinic-IDIPAPS, Barcelona, Spain.
Graciela
G
Martinez-Palli
Anestesiology Department, ICMDiM, Hospital Clinic-IDIPAPS, Barcelona, Spain.
Jaume
J
Balust
Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain.
Josep Antoni
JA
Bombi
Surgery Department, Hospital Clinic, Barcelona, Spain.
Antonio
A
de Lacy
Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain.
Antoni
A
Castells
Gastroenterology Department, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain.
Francesc
F
Balaguer
Pathology Department-Centre de Diagnostic Biomedic (CDB), Hospital Clínic, University of Barcelona (CIBERehd) and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Escala 3, Planta 5, Villarroel 170, 08036, Barcelona, Spain. mcuatrec@clinic.ub.es.
Miriam
M
Cuatrecasas
D000236:Adenoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002277:Carcinoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D053539:Keratin-19 / Q000378:metabolism; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D015996:Survival Rate; D013653:Tattooing / Q000379:methods*; D047368:Tumor Burden
D053539:Keratin-19
Colorectal cancer; Endoscopic tattooing; India ink; Lymph nodes; OSNA