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Ex vivo sentinel lymph node mapping in colorectal cancer using a magnetic nanoparticle tracer to improve staging accuracy: a pilot study
Author(s) -
Pouw J. J.,
Grootendorst M. R.,
Klaase J. M.,
Baarlen J.,
Haken B.
Publication year - 2016
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13395
Subject(s) - medicine , ex vivo , colorectal cancer , sentinel lymph node , lymph , tracer , lymph node , in vivo , radiology , cancer , oncology , pathology , microbiology and biotechnology , breast cancer , biology , physics , nuclear physics
Aim Nodal status is the most important prognostic factor in colorectal cancer ( CRC ). Small occult metastases may remain undetected on conventional histopathological examination, potentially resulting in undertreatment. Ex vivo sentinel lymph node mapping ( SLNM ) can be used to improve the accuracy of nodal staging, but the currently used tracers suffer from drawbacks, which hamper implementation of the technique in routine clinical practice. Magnetic tracers are the optimal size for sentinel lymph node ( SLN ) retention and allow objective quantitative selection of SLN s; they therefore have great potential for SLNM in CRC . The study evaluates the feasibility of ex vivo magnetic SLNM and compares the performance of this technique with blue dye SLNM . Method Twenty‐eight ex vivo SLNM procedures were performed in 27 histological node‐negative patients with CRC using a magnetic tracer and blue dye. A magnetometer was used to select magnetic SLN s after formalin fixation of the CRC specimen. Both magnetic and blue SLN s were subjected to serial sectioning and immunohistochemical staining to reveal occult metastases. Results At least one SLN was successfully identified in 27/28 (96%) and 25/28 (89%) of the cases with the magnetic technique and blue dye. Isolated tumour cells were detected in 10 patients. This was predicted with 100% sensitivity and accuracy using the magnetic technique, and with 91% sensitivity and 96% accuracy using the blue dye technique. Conclusion This study demonstrates that ex vivo magnetic SLNM is a feasible technique for use in routine clinical practice, improving nodal staging accuracy of CRC patients.