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International Journal of Colorectal Disease

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01-02-2007 | Original Article

Detection of micrometastases and skip metastases with ex vivo sentinel node mapping in carcinoma of the colon and rectum

Authors: Gokhan Yagci, Aytekin Unlu, Bulent Kurt, Mehmet Fatih Can, Nihat Kaymakcioglu, Sadettin Cetiner, Turgut Tufan, Dervis Sen

Published in: International Journal of Colorectal Disease | Issue 2/2007

Abstract

Background

The debate over sentinel lymph node mapping (SLNM) and focused pathologic examination to detect micrometastases in patients with colorectal cancer (CRC) continues. We present in this paper our experience with SLNM for CRCs to improve staging. In addition, we have detailed the mapping procedure on an anatomical basis to define skip metastasis.

Materials and methods

Forty-seven patients underwent ex vivo SLNM. Immediately after resection, 1 ml of patent blue VF was injected submucosally around the tumor. Lymph nodes harvested from the first 15 patients were mapped in a standard fashion as the blue-stained nodes (SLNs), and the others (non-SLNs) were dissected away. In the remaining 32 patients, the lymph nodes were also mapped separately in relation to their anatomic location and described as epicolic-paracolic, intermediate, and principal. The blue-stained nodes (SLNs) and non-SLNs, negative by hematoxylin and eosin stain, were further stained with cytokeratin immunohistochemical analysis and carcinoembryonic antigen.

Results

A total of 873 histologically confirmed LNs were examined with a mean of 18.6±8.1 nodes per patient. In 46 of 47 patients (97.8%), SLNs were identified. Immunohistochemical staining revealed micrometastases in the lymph nodes of four patients, which were negative by conventional methods. Anatomical skip metastases were noted in 4 of 32 patients studied (12.5%).

Conclusion

Ex vivo SLNM in CRCs is a feasible technique with a high SLN identification rate. Results of anatomical mapping of lymph nodes correlates with the limited literature, suggesting that occult skip metastases can occur in the apical lymph node group and may occur outside the resected area.

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Title: Detection of micrometastases and skip metastases with ex vivo sentinel node mapping in carcinoma of the colon and rectum
Authors: Gokhan Yagci
Aytekin Unlu
Bulent Kurt
Mehmet Fatih Can
Nihat Kaymakcioglu
Sadettin Cetiner
Turgut Tufan
Dervis Sen
Publication date: 01-02-2007
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 2/2007
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-006-0132-7

At a glance: The STEP trials

Springer Medicine

Detection of micrometastases and skip metastases with ex vivo sentinel node mapping in carcinoma of the colon and rectum

Abstract

Background

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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