The sentinel node procedure in colon carcinoma: a multi-centre study in The Netherlands

Area of Science:

• Oncology
• Surgical Pathology

Background:

• Lymph node status is critical for predicting outcomes in colorectal carcinoma.
• Up to 20% of patients without detectable lymph node metastases experience recurrence.
• Sentinel lymph node (SLN) biopsy aids in identifying micrometastatic disease and aberrant lymphatic drainage.

Purpose of the Study:

• To assess the feasibility of in vivo SLN detection in a multi-center setting for colon cancer.
• To evaluate nodal micro-staging using immunohistochemistry (IHC).

Main Methods:

• Sub-serosal injection of Patent Blue dye for SLN procedure in 69 localized colon cancer patients across six Dutch hospitals.
• SLN examination using routine hematoxylin-eosin staining.
• Immunohistochemistry (CK7/8 or 18) performed on tumor-negative SLNs.

Main Results:

• The SLN procedure was successful in 97% of patients (67/69).
• High accuracy (96%) and negative predictive value (93%) were observed.
• SLN biopsy identified micrometastases in 18% of patients, leading to upstaging, and detected aberrant lymphatic drainage in 4%.

Conclusions:

• The SLN procedure is a reliable and feasible method in a multi-center setting for localized colon carcinoma.
• SLN biopsy effectively identifies patients with occult metastases who may benefit from adjuvant therapy.
• This technique improves staging accuracy for stage II colon cancer patients.