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Assessment of Sentinel Lymph Node Biopsy in Colon Cancer and Its Impact on Staging

Received: 26 October 2015     Accepted: 26 October 2015     Published: 23 February 2016
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Abstract

Background: Missed nodal metastases during resection for colon cancer or missed occult metastases during pathological examination leads to down staging of the disease and increase the recurrence rate. The sentinel lymph node is a technique used to properly detect nodal metastases hence improving staging accuracy with subsequent proper application of adjuvant therapy. The aim of this study is to determine the feasibility of sentinel lymph node technique and its effect on staging of the disease. Methods: A total number of forty five patients with primary colon cancer (T1-3, any N, M0) were enrolled in the study. They were subjected to appropriate colonic resection based on the anatomic location of the tumor. A combined method of lymphatic mapping using technetium 99mTc -labeled sulfur colloid and patent blue was performed. After few minutes of injecting the tracers, the colon and its mesentery were examined for any blue-stained glands and areas of high radioactivity using a hand-held gamma probe. After colonic resection, the sentinel lymph node(s) and non-sentinel lymph nodes were sent for H&E staining. Positive sentinel lymph node(s) underwent no further analysis while negative nodes were submitted for immunohistochemical staining. Results: Sentinel lymph node(s) were successfully identified in 43 patients (95.6%) with a mean of 1.7 node/patient. The false negative rate is 7.1%, Sensitivity is 92.9%, specificity is 100%, negative predictive value is 88.2% and positive predictive value is 100%. Detailed focused examination using the immunohistochemical staining discovered 4 more positive patients who were supposed to be negative by the ordinary H&E staining resulting in upstaging rate of 9.3% among the whole study group and 21% among the negative-nodes patients. Conclusion: Sentinel lymph node mapping is a feasible technique with a relatively high identification rate. It can upstage some patients who will get benefit from further adjuvant chemotherapy resulting in reduced recurrence and better prognosis.

Published in Journal of Surgery (Volume 4, Issue 2-1)

This article belongs to the Special Issue Gastrointestinal Surgery: Recent Trends

DOI 10.11648/j.js.s.2016040201.18
Page(s) 36-40
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Sentinel Lymph Node, Lymphatic Mapping, Colon Cancer, Upstaging

References
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Cite This Article
  • APA Style

    Emad Hokkam, Soliman El-Kammash, Amr Abdelaziz, Sherif Farrag, Hamada Fathy, et al. (2016). Assessment of Sentinel Lymph Node Biopsy in Colon Cancer and Its Impact on Staging. Journal of Surgery, 4(2-1), 36-40. https://doi.org/10.11648/j.js.s.2016040201.18

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    ACS Style

    Emad Hokkam; Soliman El-Kammash; Amr Abdelaziz; Sherif Farrag; Hamada Fathy, et al. Assessment of Sentinel Lymph Node Biopsy in Colon Cancer and Its Impact on Staging. J. Surg. 2016, 4(2-1), 36-40. doi: 10.11648/j.js.s.2016040201.18

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    AMA Style

    Emad Hokkam, Soliman El-Kammash, Amr Abdelaziz, Sherif Farrag, Hamada Fathy, et al. Assessment of Sentinel Lymph Node Biopsy in Colon Cancer and Its Impact on Staging. J Surg. 2016;4(2-1):36-40. doi: 10.11648/j.js.s.2016040201.18

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  • @article{10.11648/j.js.s.2016040201.18,
      author = {Emad Hokkam and Soliman El-Kammash and Amr Abdelaziz and Sherif Farrag and Hamada Fathy and Ahmed Gomaa},
      title = {Assessment of Sentinel Lymph Node Biopsy in Colon Cancer and Its Impact on Staging},
      journal = {Journal of Surgery},
      volume = {4},
      number = {2-1},
      pages = {36-40},
      doi = {10.11648/j.js.s.2016040201.18},
      url = {https://doi.org/10.11648/j.js.s.2016040201.18},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.s.2016040201.18},
      abstract = {Background: Missed nodal metastases during resection for colon cancer or missed occult metastases during pathological examination leads to down staging of the disease and increase the recurrence rate. The sentinel lymph node is a technique used to properly detect nodal metastases hence improving staging accuracy with subsequent proper application of adjuvant therapy. The aim of this study is to determine the feasibility of sentinel lymph node technique and its effect on staging of the disease. Methods: A total number of forty five patients with primary colon cancer (T1-3, any N, M0) were enrolled in the study. They were subjected to appropriate colonic resection based on the anatomic location of the tumor. A combined method of lymphatic mapping using technetium 99mTc -labeled sulfur colloid and patent blue was performed. After few minutes of injecting the tracers, the colon and its mesentery were examined for any blue-stained glands and areas of high radioactivity using a hand-held gamma probe. After colonic resection, the sentinel lymph node(s) and non-sentinel lymph nodes were sent for H&E staining. Positive sentinel lymph node(s) underwent no further analysis while negative nodes were submitted for immunohistochemical staining. Results: Sentinel lymph node(s) were successfully identified in 43 patients (95.6%) with a mean of 1.7 node/patient. The false negative rate is 7.1%, Sensitivity is 92.9%, specificity is 100%, negative predictive value is 88.2% and positive predictive value is 100%. Detailed focused examination using the immunohistochemical staining discovered 4 more positive patients who were supposed to be negative by the ordinary H&E staining resulting in upstaging rate of 9.3% among the whole study group and 21% among the negative-nodes patients. Conclusion: Sentinel lymph node mapping is a feasible technique with a relatively high identification rate. It can upstage some patients who will get benefit from further adjuvant chemotherapy resulting in reduced recurrence and better prognosis.},
     year = {2016}
    }
    

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  • TY  - JOUR
    T1  - Assessment of Sentinel Lymph Node Biopsy in Colon Cancer and Its Impact on Staging
    AU  - Emad Hokkam
    AU  - Soliman El-Kammash
    AU  - Amr Abdelaziz
    AU  - Sherif Farrag
    AU  - Hamada Fathy
    AU  - Ahmed Gomaa
    Y1  - 2016/02/23
    PY  - 2016
    N1  - https://doi.org/10.11648/j.js.s.2016040201.18
    DO  - 10.11648/j.js.s.2016040201.18
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 36
    EP  - 40
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.s.2016040201.18
    AB  - Background: Missed nodal metastases during resection for colon cancer or missed occult metastases during pathological examination leads to down staging of the disease and increase the recurrence rate. The sentinel lymph node is a technique used to properly detect nodal metastases hence improving staging accuracy with subsequent proper application of adjuvant therapy. The aim of this study is to determine the feasibility of sentinel lymph node technique and its effect on staging of the disease. Methods: A total number of forty five patients with primary colon cancer (T1-3, any N, M0) were enrolled in the study. They were subjected to appropriate colonic resection based on the anatomic location of the tumor. A combined method of lymphatic mapping using technetium 99mTc -labeled sulfur colloid and patent blue was performed. After few minutes of injecting the tracers, the colon and its mesentery were examined for any blue-stained glands and areas of high radioactivity using a hand-held gamma probe. After colonic resection, the sentinel lymph node(s) and non-sentinel lymph nodes were sent for H&E staining. Positive sentinel lymph node(s) underwent no further analysis while negative nodes were submitted for immunohistochemical staining. Results: Sentinel lymph node(s) were successfully identified in 43 patients (95.6%) with a mean of 1.7 node/patient. The false negative rate is 7.1%, Sensitivity is 92.9%, specificity is 100%, negative predictive value is 88.2% and positive predictive value is 100%. Detailed focused examination using the immunohistochemical staining discovered 4 more positive patients who were supposed to be negative by the ordinary H&E staining resulting in upstaging rate of 9.3% among the whole study group and 21% among the negative-nodes patients. Conclusion: Sentinel lymph node mapping is a feasible technique with a relatively high identification rate. It can upstage some patients who will get benefit from further adjuvant chemotherapy resulting in reduced recurrence and better prognosis.
    VL  - 4
    IS  - 2-1
    ER  - 

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Author Information
  • Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

  • Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

  • Department of Pathology, Faculty, Suez Canal University, Ismailia, Egypt

  • Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

  • Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

  • Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

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