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Ex vivo sentinel lymph node biopsy in colorectal cancer: A feasibility study
Author(s) -
Fitzgerald T.L.,
Khalifa M.A.,
Al Zahrani M.,
Law C.H.L.,
Smith A.J.
Publication year - 2002
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.10091
Subject(s) - medicine , ex vivo , sentinel lymph node , biopsy , colorectal cancer , cancer , cytokeratin , pathology , rectum , stage (stratigraphy) , lymph , in vivo , surgery , breast cancer , immunohistochemistry , biology , paleontology , microbiology and biotechnology
Background and Objectives Sentinel lymph node (SLN) biopsy may improve staging of colorectal cancer. We tested the feasibility of ex vivo SLN dissection. Materials and Methods Patients undergoing resection of a primary colorectal cancer were included in this study. SLN identification involved ex vivo injection of 1 cc isosulfan blue dye subserosally in the colon or submucosally in the rectum on a separate field. SLNs were cut at 2 mm intervals. Three hematoxylin and eosin‐stained (HE) sections were prepared in addition to a middle level for cytokeratin immunostaining. Results Twenty‐six patients with varying tumor location and stage were enrolled and the SLN was identified in 88% (23/26) cases. Three failures occurred in patients with rectal cancer. The average number of SLN harvested was 2.5. The status of the nodal basin was accurately predicted in 91% (21/23) of patients. Two false negative sentinel lymph nodes were harvested in 2 of 3 patients with stage III/IV colorectal cancer. The SLN upstaged 2 patients as a result of HE stained step sections (n = 1) and immunostaining (n = 1). Conclusions This data suggests that ex vivo SLN biopsy is feasible in colorectal cancer. Although ex vivo SLN biopsy does not alter the lymphatic dissection, it may upstage a subset of patients. The ex vivo technique may be less applicable in rectal cancer and false negative results may occur. J. Surg. Oncol. 2002;80:27–32. © 2002 Wiley‐Liss, Inc.