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Skip metastases in colon cancer: assessment by lymph node mapping using molecular detection
A E Merrie1, L V Phillips, K Yun
1Departments of Surgery and Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Surgery
|June 8, 2001
Summary
Molecular techniques reveal a higher incidence of skip metastases in colon cancer than previously assumed. This challenges the traditional view of sequential lymphatic spread, suggesting a more complex pattern of colon cancer metastasis.
Area of Science:
- Oncology
- Molecular Biology
- Surgical Pathology
Background:
- Colon cancer traditionally believed to spread sequentially through lymph nodes.
- Skip metastases (non-contiguous spread) are reported in only 1-3% of cases.
- Molecular techniques can detect occult metastases but haven't been used to study lymphatic spread patterns.
Purpose of the Study:
- To investigate the pattern of regional lymphatic spread in colon cancer using molecular techniques.
- To determine the incidence of skip metastases in colon adenocarcinoma.
- To challenge the established model of sequential lymph node involvement.
Main Methods:
- Studied 55 colonic adenocarcinoma tumors from 54 patients.
- Performed lymph node mapping on fresh specimens.
- Assayed lymph nodes for keratin 20 gene expression using RT-PCR alongside routine histology.
Main Results:
- Analyzed 1084 lymph nodes; 20 had histological metastases, 13 had occult metastases.
- No difference in distribution of histological or occult metastases among node groups.
- Identified 10 patients with anatomical skip lesions, only 1 detectable by histology.
Conclusions:
- Molecular analysis reveals a higher incidence of skip metastases in colon cancer.
- Findings challenge the concept of sequential development of early lymph node metastases.
- Suggests a more complex lymphatic spread pattern in colon cancer than previously understood.