The effect of colonoscopic tattooing on lymph node retrieval and sentinel lymph node mapping
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Updated: May 20, 2026
Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
Published on: August 19, 2021
Sanne A L Bartels1, Edwin S van der Zaag, Evelien Dekker
1Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Background:
In colorectal cancer (CRC), colonoscopic tattooing is performed to mark the tumor site before laparoscopic surgery.
Objective:
To determine whether colonoscopic tattooing can be used to refine staging accuracy by increasing the lymph node (LN) yield per specimen and to determine its accuracy as a sentinel LN procedure.
Design:
Retrospective, case-control study. All LNs were microscopically examined for the presence of carbon particles.
Setting:
A university hospital and a teaching hospital.
Patients:
A consecutive series of 95 tattooed patients who had surgery for CRC between 2005 and 2009. A series of 210 non-tattooed patients who had surgery in the same time period served as controls.
Main Outcome Measurements:
Total number of LNs retrieved, detection rate, and sensitivity of tattooing as a sentinel node procedure.
Results:
A higher LN yield was observed in patients with preoperative tattooing, median (interquartile range) 15 (10-20) versus 12 (9-16), (P = .014). In multivariable analysis, the presence of carbon-containing LNs was an independent predictive factor for a higher LN yield (P = .002). The detection rate was 71%, with a median of 5 carbon-containing LNs per specimen. If preoperative tattooing was used for sentinel node mapping, the overall accuracy of predicting LN status was 94%. In the 24 N1 cases, there were 4 false-negative procedures (sensitivity 83%).
Limitations:
Retrospective series.
Conclusion:
After tattooing of CRC, the LN yield was higher than in a control group, and it could be used as a sentinel node procedure with acceptable accuracy rates. Because LN yield and sentinel node mapping are associated with improved diagnostic accuracy of LN involvement, preoperative tattooing can refine staging.
