Volume 4, Issue 2-1, March 2016, Page: 36-40
Assessment of Sentinel Lymph Node Biopsy in Colon Cancer and Its Impact on Staging
Emad Hokkam, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Soliman El-Kammash, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Amr Abdelaziz, Department of Pathology, Faculty, Suez Canal University, Ismailia, Egypt
Sherif Farrag, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Hamada Fathy, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Ahmed Gomaa, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Received: Oct. 26, 2015;       Accepted: Oct. 26, 2015;       Published: Feb. 23, 2016
DOI: 10.11648/j.js.s.2016040201.18      View  4066      Downloads  128
Background: Missed nodal metastases during resection for colon cancer or missed occult metastases during pathological examination leads to down staging of the disease and increase the recurrence rate. The sentinel lymph node is a technique used to properly detect nodal metastases hence improving staging accuracy with subsequent proper application of adjuvant therapy. The aim of this study is to determine the feasibility of sentinel lymph node technique and its effect on staging of the disease. Methods: A total number of forty five patients with primary colon cancer (T1-3, any N, M0) were enrolled in the study. They were subjected to appropriate colonic resection based on the anatomic location of the tumor. A combined method of lymphatic mapping using technetium 99mTc -labeled sulfur colloid and patent blue was performed. After few minutes of injecting the tracers, the colon and its mesentery were examined for any blue-stained glands and areas of high radioactivity using a hand-held gamma probe. After colonic resection, the sentinel lymph node(s) and non-sentinel lymph nodes were sent for H&E staining. Positive sentinel lymph node(s) underwent no further analysis while negative nodes were submitted for immunohistochemical staining. Results: Sentinel lymph node(s) were successfully identified in 43 patients (95.6%) with a mean of 1.7 node/patient. The false negative rate is 7.1%, Sensitivity is 92.9%, specificity is 100%, negative predictive value is 88.2% and positive predictive value is 100%. Detailed focused examination using the immunohistochemical staining discovered 4 more positive patients who were supposed to be negative by the ordinary H&E staining resulting in upstaging rate of 9.3% among the whole study group and 21% among the negative-nodes patients. Conclusion: Sentinel lymph node mapping is a feasible technique with a relatively high identification rate. It can upstage some patients who will get benefit from further adjuvant chemotherapy resulting in reduced recurrence and better prognosis.
Sentinel Lymph Node, Lymphatic Mapping, Colon Cancer, Upstaging
To cite this article
Emad Hokkam, Soliman El-Kammash, Amr Abdelaziz, Sherif Farrag, Hamada Fathy, Ahmed Gomaa, Assessment of Sentinel Lymph Node Biopsy in Colon Cancer and Its Impact on Staging, Journal of Surgery. Special Issue: Gastrointestinal Surgery: Recent Trends. Vol. 4, No. 2-1, 2016, pp. 36-40. doi: 10.11648/j.js.s.2016040201.18
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Attaallah W. Gunal O. Manukyan M. Ozden G. Yegen C. Prognostic impact of the metastatic LN ratio on survival in rectal cancer. Ann Coloproctol. 2013 Jun; 29(3): 100-5.
Wong SL. LN counts and survival rates after resection for colon and rectal cancer. Gastrointest Cancer Res. 2009 Mar; 3(2 Suppl): S33-5.
Van der Zaag ES. Buskens CJ. Kooij N. Akol H. Peters HM. Bouma WH. Bemelman WA. Improving staging accuracy in colon and rectal cancer by sentinel LNmapping: a comparative study.Eur J SurgOncol. 2009 Oct; 35(10): 1065-70.
International multicentre pooled analysis of B2 colon cancer trials (IMPACT B2). J ClinOncol 1999; 17: 1356-63.
Goldstein NS. Sanford W. Copffey M. Layfield LJ. LN recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and a recommendation for a minimum number of LNs to be recovered. Am J ClinPathol 1996; 106: 209-16.
Resch A and Langner C. LN staging in colorectal cancer: Old controversies and recent advances. World J Gastroenterol. 2013 Dec 14; 19(46): 8515–8526.
Joseph NE, Sigurdson ER, Hanlon AL, et al. Accuracy of determining nodal negativity in colorectal cancer onthe basis of the number of nodes retrieved on resection. Ann SurgOncol 2003; 10: 213-18.
Joseph NE, Sigurdson ER, Hanlon AL, Wang H, Mayer RJ, MacDonald JS, Catalano PJ, Haller DG. Accuracy of determining nodal negativity in colorectal cancer on the basis of the number of nodes retrieved on resection.Ann SurgOncol. 2003 Apr; 10(3): 213-8.
Tsavellas G, Patel H, Allen-Mersh TG. Detection and clinical significance of occult tumour cells in colorectal cancer. Br J Surg. 2001 Oct; 88(10): 1307-20.
Gusterson, B. Are micrometastases clinically relevant? British Journal of Hospital Medicine. 1992; 47: 247–248.
Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. LN evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007 Mar 21; 99(6): 433-41.
van der Pas M, Meijer S, Hoekstra OS, Riphagen II, de Vet HC, Knol DL, van Grieken NC, Meijerink WJ. Sentinel-lymph-node procedure in colon and rectal cancer: a systematic review and meta-analysis. Lancet Oncol. 2011 Jun; 12(6): 540-50.
Stojadinovic A, Nissan A, Protic M, Adair CF, Prus D, Usaj S, Howard RS, Radovanovic D, Breberina M, Shriver CD, Grinbaum R, Nelson JM, Brown TA, Freund HR, Potter JF, Peretz T, Peoples GE. Prospective randomized study comparing sentinel LN evaluation with standard pathologic evaluation for the staging of colon carcinoma: results from the United States Military Cancer Institute Clinical Trials Group Study GI-01.Ann Surg. 2007 Jun; 245(6): 846-57.
Albayrak Y, Oren D, Gündoğdu C, Kurt A. Intraoperative sentinel LN mapping in patients with colon cancer: study of 38 cases. Turk J Gastroenterol. 2011 Jun; 22(3): 286-92.
de Haas RJ, Wicherts DA, Hobbelink MG, van Diest PJ, Vleggaar FP, BorelRinkes IH, van Hillegersberg R. Sentinel LN mapping in colon cancer using radiocolloid as a single tracer: a feasibility study. Nucl Med Commun. 2012 Aug; 33(8): 832-7.
Bembenek A, Schneider U, Gretschel S, Fischer J, Schlag PM. Detection of LNmicrometastases and isolated tumor cells in sentinel and nonsentinelLNs of colon cancer patients. World J Surg. 2005 Sep; 29(9): 1172-5.
Coccetta M, Covarelli P, Cirocchi R, Boselli C, Santoro A, Cacurri A, Grassi V, Barillaro I, Koltraka B, Spizzirri A, Pressi E, Trastulli S, Gullà N, Noya G, Sciannameo F. The sentinel LN mapping in colon cancer. G Chir. 2010 Nov-Dec; 31(11-12): 556-9.
Rosso KJ, Nathanson SD. Techniques that accurately identify the sentinel LN in cancer. World J SurgProced. 2015 March 28; 5(1): 14-26.
Saha S, Dan AG, Berman B, Wiese D, Schochet E, Barber K, Choudhri S, Kaushal S, Ganatra B, Desai D, NagarajuM, Mannam S. Lymphazurin 1% versus 99mTc sulfur colloid for lymphatic mapping in colorectaltumors: a comparative analysis. Ann SurgOncol. 2004 Jan; 11(1): 21-6.
Trocha SD, Nora DT, Saha SS, Morton DL, Wiese D, Bilchik AJ. Combination probe and dye-directed lymphatic mapping detects micrometastases in early colorectal cancer. J Gastrointest Surg. 2003 Mar-Apr; 7(3): 340-5.
Saha S, Nora D, Wong JH, Weise D. Sentinel LNmapping in colorectal cancer. a review. SurgClin North Am. 2000 Dec; 80(6): 1811-9.
American Cancer Society. Cancer Facts & Figures 2015. Atlanta: American Cancer Society; 2015.
Stojadinovic A, Allen PJ, Protic M, Potter JF, Shriver CD, Nelson JM, Peoples GE. Colon sentinel LN mapping: practical surgical applications. J Am Coll Surg. 2005 Aug; 201(2): 297-313.
Sandrucci S, Mussa B, Goss M, Mistrangelo M, Satolli MA, Sapino A, Bellò M, Bisi G, Mussa A. Lymphoscintigraphic localization of sentinel node in early colorectal cancer: results of a monocentric study. J SurgOncol. 2007 Nov 1; 96(6): 464-9.
Leong SP, Kitagawa Y, Kitajima M. Sentinel LN mapping in colon and rectal cancer. In: Selective sentinel lymphadenectomy for human solid cancer. Springer Science & Business Media; 2005. P. 109.
Feig BW, Curley S, Lucci A, Hunt KK, Vauthey JN, Mansfield PF, Cleary K, Hamilton S, Ellis V, Brame M, Berger DH. A caution regarding lymphatic mapping in patients with colon cancer. Am J Surg. 2001 Dec; 182(6): 707-12.
Bilchik AJ, Trocha SD. Lymphatic mapping and sentinel node analysis to optimize laparoscopic resection and staging of colorectal cancer: an update. Cancer control. 2003 May-Jun; 10(3): 219-23.
Patten LC, Berger DH, Rodriguez-Bigas M, Mansfield P, Delpassand E, Cleary KR, Fagan SP, Curley SA, Hunt KK, Feig BD. A prospective evaluation of radiocolloid and immunohisochemical staining in colon carcinoma lymphatic mapping. Cancer. 2004 May 15; 100(10): 2104-9.
Merrie AE, Phillips LV, Yun K, McCall JL. Skip metastases in colon cancer: assessment by LN mapping using molecular detection. Surgery. 2001 Jun; 129(6): 684-91.
Browse journals by subject