Laparoscopic lymphatic mapping and sentinel lymph node detection in colon cancer

Technical aspects and preliminary results

Paolo Pietro Bianchi, Chiara Ceriani, Matteo Rottoli, Guido Torzilli, Massimo Roncalli, Antonino Spinelli, Marco Montorsi

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: The utility of lymph node mapping to improve staging in colon cancer is under evaluation. Laparoscopic colectomy for colon cancer has been validated in multicentric trials. This study assessed the feasibility of lymph node mapping in laparoscopic colectomy for colon cancer. Methods: From March 2004 to December 2005, 22 patients were studied. Before resection, 2 to 3 ml of Patent Blue V dye was injected subserosally around the tumor. Colored lymph nodes were marked as sentinel nodes (SNs) with metal clips, and laparoscopic colectomy with lymphadenectomy was completed as normal. In SNs, multiple 4-μm slices at 50-μm intervals were stained with hematoxylin and eosin and examined. Anticytokeratin antibody immunostaining was applied in doubtful cases. Other lymph nodes were examined with multiple slices at 100- to 500-μm intervals by standard methods. Results: The SN detection rate was 100%, although ex vivo lymph node mapping was necessary for an obese patient. Five patients (22.7%) were SN positive. There was one false-negative SN (16.7%). In two cases (9.1%) with aberrant lymphatic drainage, lymphadenectomy was extended. The SN reflected the status of the regional lymph nodes in 21 patients (95.4%). Accuracy was 95.4%, and negative predictive value was 94.1%. Conclusions: Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. Although the false-negative rate was high (16.7%), the overall results are promising and justify prospective studies to determine the real accuracy and false-negative rate for the technique.

Original languageEnglish
Pages (from-to)1567-1571
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume21
Issue number9
DOIs
Publication statusPublished - Sep 2007

Fingerprint

Colonic Neoplasms
Colectomy
Lymph Nodes
Lymph Node Excision
Feasibility Studies
Hematoxylin
Eosine Yellowish-(YS)
Sentinel Lymph Node
cyhalothrin
Surgical Instruments
Drainage
Coloring Agents
Metals
Prospective Studies
Antibodies
Neoplasms

Keywords

  • Colon carcinoma
  • Laparoscopy
  • Lymphatic mapping
  • Sentinel lymph node
  • Staging

ASJC Scopus subject areas

  • Surgery

Cite this

@article{86d732cb148547018fe59cda1fdba289,
title = "Laparoscopic lymphatic mapping and sentinel lymph node detection in colon cancer: Technical aspects and preliminary results",
abstract = "Background: The utility of lymph node mapping to improve staging in colon cancer is under evaluation. Laparoscopic colectomy for colon cancer has been validated in multicentric trials. This study assessed the feasibility of lymph node mapping in laparoscopic colectomy for colon cancer. Methods: From March 2004 to December 2005, 22 patients were studied. Before resection, 2 to 3 ml of Patent Blue V dye was injected subserosally around the tumor. Colored lymph nodes were marked as sentinel nodes (SNs) with metal clips, and laparoscopic colectomy with lymphadenectomy was completed as normal. In SNs, multiple 4-μm slices at 50-μm intervals were stained with hematoxylin and eosin and examined. Anticytokeratin antibody immunostaining was applied in doubtful cases. Other lymph nodes were examined with multiple slices at 100- to 500-μm intervals by standard methods. Results: The SN detection rate was 100{\%}, although ex vivo lymph node mapping was necessary for an obese patient. Five patients (22.7{\%}) were SN positive. There was one false-negative SN (16.7{\%}). In two cases (9.1{\%}) with aberrant lymphatic drainage, lymphadenectomy was extended. The SN reflected the status of the regional lymph nodes in 21 patients (95.4{\%}). Accuracy was 95.4{\%}, and negative predictive value was 94.1{\%}. Conclusions: Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. Although the false-negative rate was high (16.7{\%}), the overall results are promising and justify prospective studies to determine the real accuracy and false-negative rate for the technique.",
keywords = "Colon carcinoma, Laparoscopy, Lymphatic mapping, Sentinel lymph node, Staging",
author = "Bianchi, {Paolo Pietro} and Chiara Ceriani and Matteo Rottoli and Guido Torzilli and Massimo Roncalli and Antonino Spinelli and Marco Montorsi",
year = "2007",
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doi = "10.1007/s00464-006-9152-1",
language = "English",
volume = "21",
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T1 - Laparoscopic lymphatic mapping and sentinel lymph node detection in colon cancer

T2 - Technical aspects and preliminary results

AU - Bianchi, Paolo Pietro

AU - Ceriani, Chiara

AU - Rottoli, Matteo

AU - Torzilli, Guido

AU - Roncalli, Massimo

AU - Spinelli, Antonino

AU - Montorsi, Marco

PY - 2007/9

Y1 - 2007/9

N2 - Background: The utility of lymph node mapping to improve staging in colon cancer is under evaluation. Laparoscopic colectomy for colon cancer has been validated in multicentric trials. This study assessed the feasibility of lymph node mapping in laparoscopic colectomy for colon cancer. Methods: From March 2004 to December 2005, 22 patients were studied. Before resection, 2 to 3 ml of Patent Blue V dye was injected subserosally around the tumor. Colored lymph nodes were marked as sentinel nodes (SNs) with metal clips, and laparoscopic colectomy with lymphadenectomy was completed as normal. In SNs, multiple 4-μm slices at 50-μm intervals were stained with hematoxylin and eosin and examined. Anticytokeratin antibody immunostaining was applied in doubtful cases. Other lymph nodes were examined with multiple slices at 100- to 500-μm intervals by standard methods. Results: The SN detection rate was 100%, although ex vivo lymph node mapping was necessary for an obese patient. Five patients (22.7%) were SN positive. There was one false-negative SN (16.7%). In two cases (9.1%) with aberrant lymphatic drainage, lymphadenectomy was extended. The SN reflected the status of the regional lymph nodes in 21 patients (95.4%). Accuracy was 95.4%, and negative predictive value was 94.1%. Conclusions: Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. Although the false-negative rate was high (16.7%), the overall results are promising and justify prospective studies to determine the real accuracy and false-negative rate for the technique.

AB - Background: The utility of lymph node mapping to improve staging in colon cancer is under evaluation. Laparoscopic colectomy for colon cancer has been validated in multicentric trials. This study assessed the feasibility of lymph node mapping in laparoscopic colectomy for colon cancer. Methods: From March 2004 to December 2005, 22 patients were studied. Before resection, 2 to 3 ml of Patent Blue V dye was injected subserosally around the tumor. Colored lymph nodes were marked as sentinel nodes (SNs) with metal clips, and laparoscopic colectomy with lymphadenectomy was completed as normal. In SNs, multiple 4-μm slices at 50-μm intervals were stained with hematoxylin and eosin and examined. Anticytokeratin antibody immunostaining was applied in doubtful cases. Other lymph nodes were examined with multiple slices at 100- to 500-μm intervals by standard methods. Results: The SN detection rate was 100%, although ex vivo lymph node mapping was necessary for an obese patient. Five patients (22.7%) were SN positive. There was one false-negative SN (16.7%). In two cases (9.1%) with aberrant lymphatic drainage, lymphadenectomy was extended. The SN reflected the status of the regional lymph nodes in 21 patients (95.4%). Accuracy was 95.4%, and negative predictive value was 94.1%. Conclusions: Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. Although the false-negative rate was high (16.7%), the overall results are promising and justify prospective studies to determine the real accuracy and false-negative rate for the technique.

KW - Colon carcinoma

KW - Laparoscopy

KW - Lymphatic mapping

KW - Sentinel lymph node

KW - Staging

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