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Ex vivo localization and immunohistochemical detection of sentinel lymph node micrometastasis in patients with colorectal cancer can upgrade tumor staging.

Wang FL, Shen F, Wan DS, Lu ZH, Li LR, Chen G, Wu XJ, Ding PR, Kong LH, Pan ZZ - Diagn Pathol (2012)

Bottom Line: The first node to stain blue was defined as the SLN.Micrometastasis were identified by ICH in 4 of the 32 patients with HE-negative stained lymph nodes, resulting in an upstaging rate 12.5% (4/32).Those without lymph node metastasis by HE staining who were upstaged by IHC detection of micrometastasis had a significantly poorer disease-free survival (p = 0.001) and overall survival (p = 0.004).

View Article: PubMed Central - HTML - PubMed

Affiliation: State Key Laboratory of Oncology in South China; Department of Colorectal Surgery, Cancer Center, Sun Yat-sen University, 651 Dongfengdong Road, Guangzhou, Guangdong, 510060, PR China.

ABSTRACT

Background: It is not clear if sentinel lymph node (SLN) mapping can improve outcomes in patients with colorectal cancers. The purpose of this study was to determine the prognostic values of ex vivo sentinel lymph node (SLN) mapping and immunohistochemical (IHC) detection of SLN micrometastasis in colorectal cancers.

Methods: Colorectal cancer specimens were obtained during radical resections and the SLN was identified by injecting a 1% isosulfan blue solution submucosally and circumferentially around the tumor within 30 min after surgery. The first node to stain blue was defined as the SLN. SLNs negative by hematoxylin and eosin (HE) staining were further examined for micrometastasis using cytokeratin IHC.

Results: A total of 54 patients between 25 and 82 years of age were enrolled, including 32 males and 22 females. More than 70% of patients were T3 or above, about 86% of patients were stage II or III, and approximately 90% of patients had lesions grade II or above. Sentinel lymph nodes were detected in all 54 patients. There were 32 patients in whom no lymph node micrometastasis were detected by HE staining and 22 patients with positive lymph nodes micrometastasis detected by HE staining in non-SLNs. In contrast only 7 SLNs stained positive with HE. Using HE examination as the standard, the sensitivity, non-detection rate, and accuracy rate of SLN micrometastasis detection were 31.8% (7/22), 68.2% (15/22), and 72.2%, respectively. Micrometastasis were identified by ICH in 4 of the 32 patients with HE-negative stained lymph nodes, resulting in an upstaging rate 12.5% (4/32). The 4 patients who were upstaged consisted of 2 stage I patients and 2 stage II patients who were upstaged to stage III. Those without lymph node metastasis by HE staining who were upstaged by IHC detection of micrometastasis had a significantly poorer disease-free survival (p = 0.001) and overall survival (p = 0.004).

Conclusion: Ex vivo localization and immunohistochemical detection of sentinel lymph node micrometastasis in patients with colorectal cancer can upgrade tumor staging, and may become a factor affecting prognosis and guiding treatment.

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Related in: MedlinePlus

Kaplan-Meier curves of overall survival in 54 patients (n=3 in group N0(i+),n=28 in group N0, Nand n=22 in group N+). Breslow estimation method was used to test differences in survival among groups.
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Figure 1: Kaplan-Meier curves of overall survival in 54 patients (n=3 in group N0(i+),n=28 in group N0, Nand n=22 in group N+). Breslow estimation method was used to test differences in survival among groups.

Mentions: The Kaplan-Meier OS curve is shown in Figure 1. The survival status of the three groups were significantly different (p = 0.003). Regardless of upstaging status, all patients were alive 1 year after they participated in the study. At the third and the fifth year, the OS of group A was reduced to 75% and 50%, respectively; that of group B also declined to 96.3% and 92.3%, respectively; and that of group C were 90.5% and 53.5% respectively.


Ex vivo localization and immunohistochemical detection of sentinel lymph node micrometastasis in patients with colorectal cancer can upgrade tumor staging.

Wang FL, Shen F, Wan DS, Lu ZH, Li LR, Chen G, Wu XJ, Ding PR, Kong LH, Pan ZZ - Diagn Pathol (2012)

Kaplan-Meier curves of overall survival in 54 patients (n=3 in group N0(i+),n=28 in group N0, Nand n=22 in group N+). Breslow estimation method was used to test differences in survival among groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472318&req=5

Figure 1: Kaplan-Meier curves of overall survival in 54 patients (n=3 in group N0(i+),n=28 in group N0, Nand n=22 in group N+). Breslow estimation method was used to test differences in survival among groups.
Mentions: The Kaplan-Meier OS curve is shown in Figure 1. The survival status of the three groups were significantly different (p = 0.003). Regardless of upstaging status, all patients were alive 1 year after they participated in the study. At the third and the fifth year, the OS of group A was reduced to 75% and 50%, respectively; that of group B also declined to 96.3% and 92.3%, respectively; and that of group C were 90.5% and 53.5% respectively.

Bottom Line: The first node to stain blue was defined as the SLN.Micrometastasis were identified by ICH in 4 of the 32 patients with HE-negative stained lymph nodes, resulting in an upstaging rate 12.5% (4/32).Those without lymph node metastasis by HE staining who were upstaged by IHC detection of micrometastasis had a significantly poorer disease-free survival (p = 0.001) and overall survival (p = 0.004).

View Article: PubMed Central - HTML - PubMed

Affiliation: State Key Laboratory of Oncology in South China; Department of Colorectal Surgery, Cancer Center, Sun Yat-sen University, 651 Dongfengdong Road, Guangzhou, Guangdong, 510060, PR China.

ABSTRACT

Background: It is not clear if sentinel lymph node (SLN) mapping can improve outcomes in patients with colorectal cancers. The purpose of this study was to determine the prognostic values of ex vivo sentinel lymph node (SLN) mapping and immunohistochemical (IHC) detection of SLN micrometastasis in colorectal cancers.

Methods: Colorectal cancer specimens were obtained during radical resections and the SLN was identified by injecting a 1% isosulfan blue solution submucosally and circumferentially around the tumor within 30 min after surgery. The first node to stain blue was defined as the SLN. SLNs negative by hematoxylin and eosin (HE) staining were further examined for micrometastasis using cytokeratin IHC.

Results: A total of 54 patients between 25 and 82 years of age were enrolled, including 32 males and 22 females. More than 70% of patients were T3 or above, about 86% of patients were stage II or III, and approximately 90% of patients had lesions grade II or above. Sentinel lymph nodes were detected in all 54 patients. There were 32 patients in whom no lymph node micrometastasis were detected by HE staining and 22 patients with positive lymph nodes micrometastasis detected by HE staining in non-SLNs. In contrast only 7 SLNs stained positive with HE. Using HE examination as the standard, the sensitivity, non-detection rate, and accuracy rate of SLN micrometastasis detection were 31.8% (7/22), 68.2% (15/22), and 72.2%, respectively. Micrometastasis were identified by ICH in 4 of the 32 patients with HE-negative stained lymph nodes, resulting in an upstaging rate 12.5% (4/32). The 4 patients who were upstaged consisted of 2 stage I patients and 2 stage II patients who were upstaged to stage III. Those without lymph node metastasis by HE staining who were upstaged by IHC detection of micrometastasis had a significantly poorer disease-free survival (p = 0.001) and overall survival (p = 0.004).

Conclusion: Ex vivo localization and immunohistochemical detection of sentinel lymph node micrometastasis in patients with colorectal cancer can upgrade tumor staging, and may become a factor affecting prognosis and guiding treatment.

Show MeSH
Related in: MedlinePlus