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Sentinel Nodes Are Identifiable in Formalin-Fixed Specimens After Surgeon-Performed Ex Vivo Sentinel Lymph Node Mapping in Colorectal Cancer

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Abstract

Background

In recent years, the technique of sentinel lymph node (SLN) mapping has been applied to colorectal cancer. One aim was to ultrastage patients who were deemed node negative by routine pathologic processing but who went on to develop systemic disease. Such a group may benefit from adjuvant chemotherapy.

Methods

With fully informed consent and ethical approval, 37 patients with primary colorectal cancer and 3 patients with large adenomas were prospectively mapped. Isosulfan blue dye (1 to 2 mL) was injected around tumors within 5 to 10 minutes of resection. After gentle massage to recreate in vivo lymph flow, specimens were placed directly into formalin. During routine pathologic analysis, all nodes were bivalved, and blue-staining nodes were noted. These later underwent multilevel step sectioning with hematoxylin and eosin and cytokeratin staining.

Results

SLNs were found in 39 of 40 patients (98% sensitivity), with an average of 4.1 SLNs per patient (range, 1–8). In 14 of 16 (88% specificity) patients with nodal metastases on routine reporting, SLN status was in accordance. Focused examination of SLNs identified occult tumor deposits in 6 (29%) of 21 node-negative patients. No metastatic cells were found in SLNs draining the three adenomas.

Conclusions

The ability to identify SLNs after formalin fixation increases the ease and applicability of SLN mapping in colorectal cancer. Furthermore, the sensitivity and specificity of this simple ex vivo method for establishing regional lymph node status were directly comparable to those in previously published reports.

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References

  1. R Midgley D Kerr (1999) ArticleTitleColorectal cancer Lancet 353 391–9 Occurrence Handle10.1016/S0140-6736(98)07127-X Occurrence Handle1:STN:280:DyaK1M7jtl2muw%3D%3D Occurrence Handle9950460

    Article  CAS  PubMed  Google Scholar 

  2. InstitutionalAuthorNameEfficacy of adjuvant fluorouracil and folinic acid in colon cancer (1995) ArticleTitleInternational Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators Lancet 345 939–44

    Google Scholar 

  3. GJ Liefers AM Cleton-Jansen CJ van de Velde et al. (1998) ArticleTitleMicrometastases and survival in stage II colorectal cancer N Engl J Med 339 223–8 Occurrence Handle10.1056/NEJM199807233390403 Occurrence Handle1:STN:280:DyaK1czivVKhuw%3D%3D Occurrence Handle9673300

    Article  CAS  PubMed  Google Scholar 

  4. AJ Bilchik DT Nora S Saha et al. (2002) ArticleTitleThe use of molecular profiling of early colorectal cancer to predict micrometastases Arch Surg 137 1377–83 Occurrence Handle10.1001/archsurg.137.12.1377 Occurrence Handle1:CAS:528:DC%2BD38Xpslens7o%3D Occurrence Handle12470104

    Article  CAS  PubMed  Google Scholar 

  5. MR Kell MJ Kerin (2004) ArticleTitleSentinel lymph node biopsy BMJ 328 1330–1 Occurrence Handle10.1136/bmj.328.7452.1330 Occurrence Handle15178590

    Article  PubMed  Google Scholar 

  6. DL Morton DR Wen JH Wong et al. (1992) ArticleTitleTechnical details of intraoperative lymphatic mapping for early stage melanoma Arch Surg 127 392–9 Occurrence Handle1:STN:280:By2B3MrhtVU%3D Occurrence Handle1558490

    CAS  PubMed  Google Scholar 

  7. AE Giuliano DM Kirgan JM Guenther DL Morton (1994) ArticleTitleLymphatic mapping and sentinel lymphadenectomy for breast cancer Ann Surg 220 391–8 Occurrence Handle1:STN:280:ByuA2sboslY%3D Occurrence Handle8092905

    CAS  PubMed  Google Scholar 

  8. RM Cabanas (1977) ArticleTitleAn approach for the treatment of penile carcinoma Cancer 39 456–66 Occurrence Handle1:STN:280:CSiC3MzntlY%3D Occurrence Handle837331

    CAS  PubMed  Google Scholar 

  9. EA Gould T Winship PH Philbin HH Kerr (1960) ArticleTitleObservations on a “sentinel node” in cancer of the parotid Cancer 13 77–8 Occurrence Handle1:STN:280:CC%2BC2cbgslQ%3D Occurrence Handle13828575

    CAS  PubMed  Google Scholar 

  10. AJ Bilchik S Saha D Wiese et al. (2001) ArticleTitleMolecular staging of early colon cancer on the basis of sentinel node analysis: a multicenter phase II trial J Clin Oncol 19 1128–36

    Google Scholar 

  11. AJ Bilchik D Nora RA Tollenaar et al. (2002) ArticleTitleUltrastaging of early colon cancer using lymphatic mapping and molecular analysis Eur J Cancer 38 977–85 Occurrence Handle10.1016/S0959-8049(02)00058-8 Occurrence Handle1:STN:280:DC%2BD383ktVyqtw%3D%3D Occurrence Handle11978523

    Article  CAS  PubMed  Google Scholar 

  12. S Saha A Bilchik D Wiese et al. (2001) ArticleTitleUltrastaging of colorectal cancer by sentinel lymph node mapping technique—a multicenter trial Ann Surg Oncol 8 IssueID9 Suppl 94S–98S Occurrence Handle1:STN:280:DC%2BD3Mrlt12rtg%3D%3D Occurrence Handle11599912

    CAS  PubMed  Google Scholar 

  13. TF Wood GJ Tsioulias DL Morton et al. (2000) ArticleTitleFocused examination of sentinel lymph nodes upstages early colorectal carcinoma Am Surg 66 998–1003 Occurrence Handle1:STN:280:DC%2BD3M%2FmvVCntg%3D%3D Occurrence Handle11090005

    CAS  PubMed  Google Scholar 

  14. TF Wood M Spirt D Rangel et al. (2001) ArticleTitleLymphatic mapping improves staging during laparoscopic colectomy for cancer Surg Endosc 15 715–9 Occurrence Handle10.1007/s004640080026 Occurrence Handle1:STN:280:DC%2BD3MrksV2ktg%3D%3D Occurrence Handle11591974

    Article  CAS  PubMed  Google Scholar 

  15. TF Wood S Saha DL Morton et al. (2001) ArticleTitleValidation of lymphatic mapping in colorectal cancer: in vivo, ex vivo, and laparoscopic techniques Ann Surg Oncol 8 150–7 Occurrence Handle1:STN:280:DC%2BD3Mzgt1agtw%3D%3D Occurrence Handle11258780

    CAS  PubMed  Google Scholar 

  16. TF Wood DT Nora DL Morton et al. (2002) ArticleTitleOne hundred consecutive cases of sentinel lymph node mapping in early colorectal carcinoma: detection of missed micrometastases J Gastrointest Surg 6 322–9 Occurrence Handle10.1016/S1091-255X(02)00013-6 Occurrence Handle12022982

    Article  PubMed  Google Scholar 

  17. A Bembenek B Rau T Moesta et al. (2004) ArticleTitleSentinel lymph node biopsy in rectal cancer—not yet ready for routine clinical use Surgery 135 498–505 Occurrence Handle10.1016/j.surg.2003.10.004 Occurrence Handle1:STN:280:DC%2BD2c3itVCquw%3D%3D Occurrence Handle15118586

    Article  CAS  PubMed  Google Scholar 

  18. Y Kitagawa M Watanabe H Hasegawa et al. (2002) ArticleTitleSentinel node mapping for colorectal cancer with radioactive tracer Dis Colon Rectum 45 1476–80 Occurrence Handle10.1007/s10350-004-6453-0 Occurrence Handle12432294

    Article  PubMed  Google Scholar 

  19. AE Merrie AM Rij Particlevan LV Phillips et al. (2001) ArticleTitleDiagnostic use of the sentinel node in colon cancer Dis Colon Rectum 44 410–7 Occurrence Handle1:STN:280:DC%2BD3M7pvFyruw%3D%3D Occurrence Handle11289289

    CAS  PubMed  Google Scholar 

  20. SD Trocha DT Nora SS Saha et al. (2003) ArticleTitleCombination probe and dye-directed lymphatic mapping detects micrometastases in early colorectal cancer J Gastrointest Surg 7 340–5 Occurrence Handle10.1016/S1091-255X(02)00192-0 Occurrence Handle12654558

    Article  PubMed  Google Scholar 

  21. JH Wong S Steineman C Calderia et al. (2001) ArticleTitleEx vivo sentinel node mapping in carcinoma of the colon and rectum Ann Surg 233 515–21 Occurrence Handle10.1097/00000658-200104000-00006 Occurrence Handle1:STN:280:DC%2BD3M3kvVajsA%3D%3D Occurrence Handle11303133

    Article  CAS  PubMed  Google Scholar 

  22. JH Wong DS Johnson T Namiki P Tauchi-Nishi (2004) ArticleTitleValidation of ex vivo lymphatic mapping in hematoxylin-eosin node-negative carcinoma of the colon and rectum Ann Surg Oncol 11 772–7 Occurrence Handle10.1245/ASO.2004.11.026 Occurrence Handle15249341

    Article  PubMed  Google Scholar 

  23. TL Fitzgerald MA Khalifa M Al Zahrani et al. (2002) ArticleTitleEx vivo sentinel lymph node biopsy in colorectal cancer: a feasibility study J Surg Oncol 80 27–32 Occurrence Handle10.1002/jso.10091 Occurrence Handle1:STN:280:DC%2BD383osVaqtQ%3D%3D Occurrence Handle11967903

    Article  CAS  PubMed  Google Scholar 

  24. CP Raut MD Daley KK Hunt et al. (2004) ArticleTitleAnaphylactoid reactions to isosulfan blue dye during breast cancer lymphatic mapping in patients given preoperative prophylaxis J Clin Oncol 22 567–8

    Google Scholar 

  25. DA Weise S Saha J Badin et al. (2000) ArticleTitlePathologic evaluation of sentinel lymph nodes in colorectal carcinoma Arch Pathol Lab Med 124 1759–63 Occurrence Handle11100053

    PubMed  Google Scholar 

  26. FM Smith JC Coffey A El Sayeed F O’Sullivan WO Kirwan HP Redmond (2003) ArticleTitleSentinel lymph node mapping in colorectal cancer Br J Surg 90 659–67 Occurrence Handle10.1002/bjs.4217 Occurrence Handle12808612

    Article  PubMed  Google Scholar 

  27. M Leidenius E Leppanen L Krogerus K von Smitten (2003) ArticleTitleMotion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer Am J Surg 185 127–30 Occurrence Handle10.1016/S0002-9610(02)01214-X Occurrence Handle12559441

    Article  PubMed  Google Scholar 

  28. J Mulsow DC Winter JC O’Keane PR O’Connell (2003) ArticleTitleSentinel lymph node mapping in colorectal cancer Br J Surg 90 659–67 Occurrence Handle10.1002/bjs.4217 Occurrence Handle12808612

    Article  PubMed  Google Scholar 

  29. CA Msuya F Hartveit (1991) ArticleTitleSkip lesions in the axilla in breast cancer and their association with micrometastases Breast Cancer Res Treat 19 277–81 Occurrence Handle1:STN:280:By2C3sros1Q%3D Occurrence Handle1663806

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Edel Galvin for her technical assistance in performing CK-IHC and Eleanor Carton for her assistance in providing surgical specimens.

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Authors and Affiliations

  1. Departments of Academic Surgery and Pathology, Cork University Hospital, Wilton, Cork, Ireland

    Fraser McLean Smith AFRCSI, John Calvin Coffey PhD, AFRCSI, Nurul Mod Khasri AFRCP, Nollaig Parfrey FRCP, William Kirwan FRCSI & H. Paul Redmond FRCSI

  2. Departments of Academic Surgery, Pathology, and Clinical and Molecular Oncology, St James’s Hospital, Dublin, Ireland

    Miriam Fiona Walsh MbBCh, BAO, Eoin Gaffney MD, Richard Stephens FRCSI & M. John Kennedy MRCPI

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  1. Fraser McLean Smith AFRCSI
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  2. John Calvin Coffey PhD, AFRCSI
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  8. M. John Kennedy MRCPI
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Corresponding author

Correspondence to H. Paul Redmond FRCSI.

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Smith, F.M., Coffey, J.C., Khasri, N.M. et al. Sentinel Nodes Are Identifiable in Formalin-Fixed Specimens After Surgeon-Performed Ex Vivo Sentinel Lymph Node Mapping in Colorectal Cancer. Ann Surg Oncol 12, 504–509 (2005). https://doi.org/10.1245/ASO.2005.08.019

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  • DOI: https://doi.org/10.1245/ASO.2005.08.019

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