A caution regarding lymphatic mapping in patients with colon cancer

Presented at the 53rd Annual Meeting of the Southwestern Surgical Congress, Cancun, Mexico, April 29–May 2, 2001.
https://doi.org/10.1016/S0002-9610(01)00803-0Get rights and content

Abstract

Background: The value of lymphatic mapping and sentinel lymph node biopsy in the treatment of colon cancer is controversial. The purpose of this study was to determine the accuracy of lymphatic mapping in patients with colon cancer.

Methods: Forty-eight patients with colon cancer underwent lymphatic mapping and sentinel lymph node biopsy using isosulfan blue dye followed by standard surgical resection. The sentinel lymph nodes underwent thin sectioning as will as immunohistochemical staining for cytokeratin, in addition to standard hematoxylin and eosin staining.

Results: In 47 (98%) patients, a sentinel lymph node was identified. Sixteen patients had lymph nodes containing metastatic disease, and in 6 patients the sentinel lymph node was positive for disease. In no patient was the sentinel lymph node the only site of metastatic disease. In 10 patients the sentinel lymph node was negative for disease, whereas the nonsentinel lymph nodes contained metastatic disease (false negative rate = 38%)

Conclusions: The role of lymphatic mapping and sentinel lymph node biopsy in colon cancer is not as clear as its role in other tumors. Further large prospective studies are needed to evaluate the accuracy and potential benefit of this procedure in patients with colon cancer.

Section snippets

Patients and methods

A prospective multicenter study was begun in February 2000 to evaluate the role of LM and SLNB in patients with colon cancer. Any patient with either a biopsy-proven colon cancer or a colon polyp suspicious for potentially harboring an invasive cancer was considered eligible for the protocol. After obtaining informed consent, patients were taken to the operating room, and after general anesthesia was induced, the LM was performed by injecting 3 to 5 cc of isosulfan blue dye (Lymphazurin;

Results

The characteristics of the 48 patients entered into the study are shown in Table 1. On average, 13 nonsentinel lymph nodes (NSLNs) and 2.6 sentinel lymph nodes (SLNs) were identified per patient. In all but 1 (98%) of the patients, at least 1 SLN was identified.

Table 2 outlines the significant tumor characteristics. The tumors were distributed relatively evenly between the right and left colon (46% versus 50%, respectively), with only an occasional patient presenting with a transverse colon

Comments

Several recent studies have suggested that intraoperative LM and SLNB are sensitive and predictive means of pathologically staging patients with colorectal cancer [9], [10]. However, controversy exists regarding both the accuracy and significance of SLNB in patients with colorectal carcinoma [11], [12]. The advantages attained in patients with melanoma and breast cancer—that of eliminating the morbidity of regional lymph node dissection as well as improved staging of patients with

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