Sentinel lymph node biopsy in colon cancer
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Sentinel lymph node biopsy in colon cancer : a prospective multicenter trial. / Bembenek, Andreas E; Rosenberg, Robert; Wagler, Elke; Gretschel, Stephan; Sendler, Andreas; Siewert, Joerg-Ruediger; Nährig, Jörg; Witzigmann, Helmut; Hauss, Johann; Knorr, Christian; Dimmler, Arno; Gröne, Jörn; Buhr, Heinz-Johannes; Haier, Jörg; Herbst, Hermann; Tepel, Juergen; Siphos, Bence; Kleespies, Axel; Koenigsrainer, Alfred; Stoecklein, Nikolas H; Horstmann, Olaf; Grützmann, Robert; Imdahl, Andreas; Svoboda, Daniel; Wittekind, Christian; Schneider, Wolfgang; Wernecke, Klaus-Dieter; Schlag, Peter M.
In: ANN SURG, Vol. 245, No. 6, 06.2007, p. 858-63.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Sentinel lymph node biopsy in colon cancer
T2 - a prospective multicenter trial
AU - Bembenek, Andreas E
AU - Rosenberg, Robert
AU - Wagler, Elke
AU - Gretschel, Stephan
AU - Sendler, Andreas
AU - Siewert, Joerg-Ruediger
AU - Nährig, Jörg
AU - Witzigmann, Helmut
AU - Hauss, Johann
AU - Knorr, Christian
AU - Dimmler, Arno
AU - Gröne, Jörn
AU - Buhr, Heinz-Johannes
AU - Haier, Jörg
AU - Herbst, Hermann
AU - Tepel, Juergen
AU - Siphos, Bence
AU - Kleespies, Axel
AU - Koenigsrainer, Alfred
AU - Stoecklein, Nikolas H
AU - Horstmann, Olaf
AU - Grützmann, Robert
AU - Imdahl, Andreas
AU - Svoboda, Daniel
AU - Wittekind, Christian
AU - Schneider, Wolfgang
AU - Wernecke, Klaus-Dieter
AU - Schlag, Peter M
PY - 2007/6
Y1 - 2007/6
N2 - 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 < or =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.
AB - 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 < or =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.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Chi-Square Distribution
KW - Colonic Neoplasms
KW - Coloring Agents
KW - Female
KW - Humans
KW - Immunohistochemistry
KW - Laparoscopy
KW - Lymph Nodes
KW - Lymphatic Metastasis
KW - Male
KW - Middle Aged
KW - Predictive Value of Tests
KW - Prognosis
KW - Prospective Studies
KW - ROC Curve
KW - Risk Factors
KW - Rosaniline Dyes
KW - Sensitivity and Specificity
KW - Sentinel Lymph Node Biopsy
U2 - 10.1097/01.sla.0000250428.46656.7e
DO - 10.1097/01.sla.0000250428.46656.7e
M3 - SCORING: Journal article
C2 - 17522509
VL - 245
SP - 858
EP - 863
JO - ANN SURG
JF - ANN SURG
SN - 0003-4932
IS - 6
ER -
