Top

Annals of Surgical Oncology

Published in:

01-02-2011 | Gastrointestinal Oncology

Sentinel Node Biopsy in Squamous-Cell Carcinoma of the Anal Canal

Authors: Paola De Nardi, MD, Michele Carvello, MD, Carla Canevari, MD, Paolo Passoni, MD, Carlo Staudacher, MD

Published in: Annals of Surgical Oncology | Issue 2/2011

Abstract

Background

Radiochemotherapy is the standard treatment for patients with carcinoma of the anal canal. Therefore, a surgical specimen is not usually obtained. Inguinal lymph node metastases cannot be accurately predicted by either clinical examination or imaging techniques. In this study, we applied the sentinel node technique in patients with anal canal squamous-cell carcinoma to determine whether this provided more reliable staging of tumors.

Methods

From May 2007 to May 2009, we enrolled 11 patients (7 women) with a mean age 65 (range 39–80) years with squamous-cell carcinoma of the anal canal and clinically and radiologically negative groin lymph nodes. The patients were staged with endorectal ultrasound, computed tomographic scan, magnetic resonance imaging of the pelvis, and positron emission tomography. There were two T1, four T2, and five T3 tumors (International Union Against Cancer classification). Lymphoscintigraphy with peritumoral 99mTc colloid injection was performed 16 to 18 h before surgery. During the surgery, patent blue dye was injected peritumorally, and the sentinel inguinal node was identified by a handheld gamma probe and dye visualization.

Results

The sentinel lymph node was detected in all 11 patients by scintigraphy; in 9 cases, the lymph node was in the inguinal region. All of these patients underwent radioguided node biopsy, and a total of 12 lymph nodes were removed. The average diameter of the resected nodes was 8 (range 4–20) mm. No serious complications occurred. In three patients, metastases were identified in the lymph node.

Conclusions

Sentinel node biopsy is a more accurate method than clinical or radiological techniques to stage the disease of patients with anal carcinoma.

Clark MA, Hartley A, Geh JI. Cancer of the anal canal. Lancet Oncol. 2004;5:149–57.PubMedCrossRef

Nigro ND, Vaitkevicious VK, Considine B. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum. 1974;17:354–6.PubMedCrossRef

Klas JV, Rothenberger DA, Wong WD, Madoff RD. Malignant tumors of the anal canal. Cancer. 1999;85:1686–93.PubMedCrossRef

Gerard JP, Chapet O, Samiei F, et al. Management of inguinal lymph node metastases in patients with carcinoma of the anal canal. Cancer. 2001;92:77–84.PubMedCrossRef

Stearns MW, Urmacher C, Sternberg SS, Woodruff J, Attieth F. Cancer of the anal canal. Curr Probl Cancer. 1980;4:2–44.CrossRef

Rabbitt P, Pathma-Nathan N, Collinson T, Hewett P, Rieger N. Sentinel lymph node biopsy for squamous cell carcinoma of the anal canal. ANZ J Surg. 2002;72:651–4.PubMedCrossRef

Trautmann TG, Zuger JH. Positron emission tomography for pretreatment staging and posttreatment evaluation in cancer of the anal canal. Mol Imaging Biol. 2005;7:309–13.PubMedCrossRef

Damin DC, Rosito MA, Schwartsmann G. Sentinel lymph node in carcinoma of the anal canal: a review. Eur J Surg Oncol. 2006;32:247–52.PubMedCrossRef

Wade DS, Herrera L, Castillo NB, Petrelli NJ. Metastases to the lymph nodes in epidermoid carcinoma of the anal canal studied by a clearing technique. Surg Gynecol Obstet. 1989;169:238–42.PubMed

10.

Pinna Pintor M, Northover JMA, Nicholls RJ. Squamous cell carcinoma of the anus at one hospital from 1948 to 1984. Br J Surg. 1989;76:806–10.CrossRef

11.

UICC International Union Against Cancer. UICC TNM Atlas. 4th ed. Berlin: Springer, 1997.

12.

Ryan PD, Compton CC, Mayer RJ. Carcinoma of the anal canal. N Engl J Med. 2000;342:792–800.PubMedCrossRef

13.

Uronis HE, Bendell JC. Anal cancer: an overview. Oncologist. 2007;12:524–34.PubMedCrossRef

14.

Bembenek A, Gretschel S, Schlag PM. Sentinel lymph node biopsy for gastrointestinal cancers. J Surg Oncol. 2007;96:342–52.PubMedCrossRef

15.

Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol. 1997;15:2040–9.PubMed

16.

UKCCCR Anal Cancer Trial Working Party. UK Coordinating Committee on Cancer Research. Epidermoid anal cancer: results from the UKCCCR randomized trials of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mytomicin. Lancet. 1996;348:1049–54.

17.

Baxter NN, Habermann EB, Tepper JE, et al. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294:2587–93.PubMedCrossRef

18.

Katz A, Eifel PJ, Jhingran A, Levenback CF. The role of radiation therapy in preventing regional recurrences of invasive squamous cell carcinoma of the vulva. Int J Radiat Oncol Biol Phys. 2003;57:409–18.PubMedCrossRef

19.

Jung H, Beck-Bornholdt HP, Svoboda V, Alberti W, Hermann T. Quantification of late complications after radiotherapy. Radiother Oncol. 2001;61:233–46.PubMedCrossRef

20.

Cummings BJ. Anal cancer. Int J Radiat Oncol Biol Phys. 1990;19:1309–15.PubMedCrossRef

21.

Schulze T, Bembenek A, Schlag PM. Sentinel lymph node biopsy progress in surgical treatment of cancer. Langenbecks Arch Surg. 2004;389:532–50.PubMedCrossRef

22.

Gretschel S, Warnick P, Bembenek A, Dresel S. Lymphatic mapping and sentinel lymph node biopsy in epidermoid carcinoma al the anal canal. Eur J Surg Oncol. 2008;3:890–84.

23.

Perera D, Pathma-Nathan N, Rabbitt P, Hewett P. Sentinel node biopsy for squamous cell carcinoma of the anus and anal margin. Dis Colon Rectum. 2003;46:1027–31.PubMedCrossRef

24.

Mistrangelo M, Bello M, Mobiglia A, Beltramo G. Feasibility of the sentinel node biopsy in anal cancer. Q J Nucl Med Mol Imaging. 2008;52:1–6.

25.

Damin DC, Rosito MA, Gus P, et al. Sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal. Dis Colon Rectum. 2003;46:1032–7.PubMedCrossRef

26.

Peley G, Farkas E, Sinkovics I, et al. Inguinal sentinel node biopsy for staging anal cancer. Scand J Surg. 2002;91:336–8.PubMed

27.

Krontiras H, Bland KI. When sentinel node biopsy for breast cancer is contraindicated? Surg Oncol. 2003;12:207–10.PubMedCrossRef

28.

Bobin JY, Gerard JP, Chapet O, Romestaing P, Isaac S. Lymphatic mapping inguinal and sentinel node biopsy in anal cancers to avoid prophylactic inguinal irradiation. Cancer Radiother. 2003;7:85S–90S.PubMed

Title: Sentinel Node Biopsy in Squamous-Cell Carcinoma of the Anal Canal
Authors: Paola De Nardi, MD
Michele Carvello, MD
Carla Canevari, MD
Paolo Passoni, MD
Carlo Staudacher, MD
Publication date: 01-02-2011
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 2/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-1275-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sentinel Node Biopsy in Squamous-Cell Carcinoma of the Anal Canal

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2011

Incidental Thyroid Carcinoma by FDG-PET/CT: A Study of Clinicopathological Characteristics

Resection Margins in Ultrasound-Guided Breast-Conserving Surgery

Variation in Lymph Node Evaluation in Rectal Cancer: A Dutch Nationwide Population-Based Study

Comparison of p53 and Epidermal Growth Factor Receptor Gene Status Between Primary Tumors and Lymph Node Metastases in Non-Small Cell Lung Cancers

Impact of Circumferential Resection Margin Distance on Locoregional Recurrence and Survival after Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

mTOR Signaling is Involved in Indomethacin and Nimesulide Suppression of Colorectal Cancer Cell Growth via a COX-2 Independent Pathway