Lymphatic Mapping and Biopsy of Sentinel Lymph Nodes Using Combined Methodology of In Vivo Application of Patentblue and Radionuclide and Ex Vivo Detection of Metastatic Affection of Lymph Nodes in Colorectal Carcinoma

Česká verzia

Authors: J. Duben ^1,2; B. Dudešek ¹; L. Hnátek ^1,2; P. Vážan ³; J. Bakala ^2,4; J. Gatěk ^1,2
Authors place of work: Chirurgické oddělení nemocnice Atlas a. s. Zlín ¹; Univerzita Tomáše Bati ve Zlíně ²; Bioptická a cytologická laboratoř, vedoucí lékař MUDr. Josef Velecký ³; Oddělení nukleární medicíny BN Zlín, přednosta prim. MUDr. Jiří Bakala ⁴
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 11, s. 695-701.
Category: Monothematic special - Original

Summary

Aim of the study:
to check the new technique of lymphatic mapping and sentinel node biopsy by colorectal cancer surgery and to improve the lymphatic staging.

Method:
combined technique of lymphatic mapping via Patentblue and the radiocolloid in vivo applied in the rectal cancer surgery. The lymphatic-mapping technique with Patentblue in the colon cancer surgery. Radically or palliative tumour resection. Ex vivo detection of sentinel and non-sentinel lymph nodes in the specimen and their division into peritumoral, intermedial and central level. Serial sectioning examination and immunohistochemistry examination of detected lymph nodes. Statistic process.

Results:
The methods were used for 107 patients. 1985 lymph nodes were examined, out of which 208 was with metastasis. Positive nodes were detected in 56 patients. In average there were 18.5 nodes per patient. 966 sentinel nodes were detected by colouring and radiocolloid marking. Sentinel nodes showed in 97 patients. In 10 patients, the method failed. In 44 patients, sentinel nodes were positive; 117 positive nodes in total. Skip metastases were detected in 6 percent of the patients. The upstaging of metastatic detection was in 3.7 percent.

Conclusion:
The technique of lymphatic mapping and sentinel node detection significantly increases the number of detected nodes and selects the marks the sentinel ones for further examination. The greatest amount of findings of nodal metastases is in the area closest to the tumour, therefore, when sentinel nodes are negative there, these can be examined more closely, by the method of serial insections or imunohistochemically, and staging of the disease can be made more accurate.

Key word:
colorectal cancer – sentinel lymph node – lymphatic mapping

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