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Sentinel Lymph Node Biopsy in Colon Cancer

2007; Lippincott Williams & Wilkins; Volume: 245; Issue: 6 Linguagem: Inglês

10.1097/01.sla.0000250428.46656.7e

1528-1140

A. Bembenek, Robert Rosenberg, Elke Wagler, Stephan Gretschel, A. Sendler, Joerg-Ruediger Siewert, Jörg Nährig, Helmut Witzigmann, Johann Hauss, Christian Knorr, Arno Dimmler, Jörn Gröne, H. J. Buhr, Jörg Haier, Hermann Herbst, Juergen Tepel, Bence Siphos, Axel Kleespies, Alfred Koenigsrainer, Nikolas H. Stoecklein, O. Horstmann, Robert Grützmann, A. Imdahl, Daniel Svoboda, Christian Wittekind, Wolfgang Schneider, Klaus–Dieter Wernecke, Peter M. Schlag,

Colorectal Cancer Treatments and Studies

In Brief Introduction: The clinical impact of sentinel lymph node biopsy (SLNB) in colon cancer is still controversial. The purpose of this prospective multicenter trial was to evaluate its clinical value to predict the nodal status and identify factors that influence these results. Methods: Colon cancer patients without prior colorectal surgery or irradiation were eligible. The sentinel lymph node (SLN) was identified intraoperatively by subserosal blue dye injection around the tumor. The SLN underwent step sections and immunohistochemistry (IHC), if classified free of metastases after routine hematoxylin and eosin examination. Results: At least one SLN (median, n = 2) was identified in 268 of 315 enrolled patients (detection rate, 85%). Center experience, lymphovascular invasion, body mass index (BMI), and learning curve were positively associated with the detection rate. The false-negative rate to identify pN+ patients by SLNB was 46% (38 of 82). BMI showed a significant association to the false-negative rate (P < 0.0001), the number of tumor-involved lymph nodes was inversely associated. If only slim patients (BMI ≤24) were investigated in experienced centers (>22 patients enrolled), the sensitivity increased to 88% (14 of 16). Moreover, 21% (30 of 141) of the patients, classified as pN0 by routine histopathology, revealed micrometastases or isolated tumor cells (MM/ITC) in the SLN. Conclusions: The contribution of SLNB to conventional nodal staging of colon cancer patients is still unspecified. Technical problems have to be resolved before a definite conclusion can be drawn in this regard. However, SLNB identifies about one fourth of stage II patients to reveal MM/ITC in lymph nodes. Further studies must clarify the clinical impact of these findings in terms of prognosis and the indication of adjuvant therapy. This multicenter trial found sentinel lymph node biopsy (SLNB) to be unreliable in predicting the nodal status of colon cancer patients. As the success depended on factors like center experience and body mass index, the results may improve by technical optimization. Further, SLNB identified 21% of stage I/II patients to have micrometastases or isolated tumor cell involvement.