Sentinel node staging of resectable colon cancer - Results of a multicenter study
Sentinel node staging of resectable colon cancer - Results of a multicenter study
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DOI：
10.1097/01.sla.000140753.41357.20
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发表时间：
2004-10-01
影响因子：
9
通讯作者：
Compton, C
中科院分区：
文献类型：
--
作者：
Bertagnolli, M;Miedema, B;Compton, C
目的和摘要背景资料：前哨淋巴结（LN）取样是一种广泛用于治疗乳腺癌和黑色素瘤的技术，旨在选择准确预测区域淋巴结状态的淋巴结，并可以广泛检查以识别标准组织病理学分期未检测到的淋巴结转移性疾病。对于可切除结肠癌患者，通过识别可能从辅助治疗中获益的患者，提高LN疾病的识别将显著推进患者护理。这项研究由13家机构的25名外科医生进行，研究了前哨淋巴结（SN）取样是否能准确预测可切除结肠癌患者的LN状态。方法：在瘤周注射1%异硫丹蓝进行SN取样，在10分钟内进行所有LN的可视化鉴定。入选的91例患者中有79例进行淋巴结淋巴结取样，随后由一名研究病理学家进行淋巴结多水平切片（MLS）和检查。结果：通过标准组织病理学检查，7例患者原发疾病为良性或非结肠癌，因此被排除在进一步研究之外。在研究的72例结肠癌病例中，48例（66%）为淋巴结阴性，24例（33%）有淋巴结转移。66例（92%）成功定位SNs，平均每例2.1个。24例淋巴结阳性患者中14例（58%）SNs阴性。其中1例MLS显示SN内肿瘤，SN假阴性率达54%。结论：本多机构研究发现，对于淋巴结阳性结肠癌患者，SN检查联合MLS不能预测54%的患者的淋巴结状态。我们的结论是，单独使用MLS的SN取样不太可能改善可切除结肠癌的风险分层。
Objective and Summary Background Data: Sentinel lymph node (LN) sampling, a technique widely used to manage breast cancer and melanoma, seeks to select LNs that accurately predict regional node status and can be extensively examined to identify nodal metastatic disease not detected by standard histopathological staging. For patients with resectable colon cancer, improved identification of LN disease would significantly advance patient care by identifying patients likely to benefit from adjuvant therapy. This study, conducted by 25 surgeons at 13 institutions, examined whether sentinel node (SN) sampling accurately predicted LN status for patients with resectable colon cancer.Methods: SN sampling involved peritumor injection of 1% isosulfan blue, followed by identification of all LN visualized within 10 minutes. SN sampling was performed on 79 of 91 patients enrolled, followed by multilevel sectioning (MLS) of the nodes and examination by a single study pathologist.Results: By standard histopathology, 7 patients had primary disease that was either benign or not colon cancer and were therefore excluded from further studies. Of 72 colon cancer cases studied, 48 (66%) were node-negative and 24 (33%) contained nodal metastases. SNs were successfully located in 66 cases (92%), with an average of 2.1 nodes per patient. SNs were negative in 14 of 24 node-positive cases (58%). MLS revealed tumor in a SN in I of these cases, bringing the false-negative rate of SN examination to 54%.Conclusion: This multi-institutional study found that for patients with node-positive colon cancer, SN examination with MLS failed to predict nodal status in 54% of cases. We conclude that SN sampling with MLS, used alone, is unlikely to improve risk stratification for resectable colon cancer.