Sentinel node staging of resectable colon cancer: Results of a multicenter study

Monica Bertagnolli, Brent Miedema, Mark Redston, Jeannette Dowell, Donna Niedzwiecki, James Fleshman, Jiri Bem, Robert Mayer, Michael Zinner, Carolyn Compton, W. Douglas Wong, Frederick L. Greene, Stanley P L Leong, Merrick I. Ross

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Objective and Summary Background Data: Sentinel lymph node (LN) sampling, a technique widely used to manage breast cancer and melanoma, seeks to select LNs that accurately predict regional node status and can be extensively examined to identify nodal metastatic disease not detected by standard histopathological staging. For patients with resectable colon cancer, improved identification of LN disease would significantly advance patient care by identifying patients likely to benefit from adjuvant therapy. This study, conducted by 25 surgeons at 13 institutions, examined whether sentinel node (SN) sampling accurately predicted LN status for patients with resectable colon cancer. Methods: SN sampling involved peritumor injection of 1% isosulfan blue, followed by identification of all LN visualized within 10 minutes. SN sampling was performed on 79 of 91 patients enrolled, followed by multilevel sectioning (MLS) of the nodes and examination by a single study pathologist. Results: By standard histopathology, 7 patients had primary disease that was either benign or not colon cancer and were therefore excluded from further studies. Of 72 colon cancer cases studied, 48 (66%) were node-negative and 24 (33%) contained nodal metastases. SNs were successfully located in 66 cases (92%), with an average of 2.1 nodes per patient. SNs were negative in 14 of 24 node-positive cases (58%). MLS revealed tumor in a SN in 1 of these cases, bringing the false-negative rate of SN examination to 54%. Conclusion: This multi-institutional study found that for patients with node-positive colon cancer, SN examination with MLS failed to predict nodal status in 54% of cases. We conclude that SN sampling with MLS, used alone, is unlikely to improve risk stratification for resectable colon cancer.

Original languageEnglish (US)
Pages (from-to)624-630
Number of pages7
JournalAnnals of Surgery
Volume240
Issue number4
DOIs
StatePublished - Oct 2004
Externally publishedYes

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Colonic Neoplasms
Multicenter Studies
Lymph Nodes
cyhalothrin
Melanoma
Patient Care
Breast Neoplasms
Neoplasm Metastasis
Injections
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Bertagnolli, M., Miedema, B., Redston, M., Dowell, J., Niedzwiecki, D., Fleshman, J., ... Ross, M. I. (2004). Sentinel node staging of resectable colon cancer: Results of a multicenter study. Annals of Surgery, 240(4), 624-630. https://doi.org/10.1097/01.sla.0000140753.41357.20

Sentinel node staging of resectable colon cancer : Results of a multicenter study. / Bertagnolli, Monica; Miedema, Brent; Redston, Mark; Dowell, Jeannette; Niedzwiecki, Donna; Fleshman, James; Bem, Jiri; Mayer, Robert; Zinner, Michael; Compton, Carolyn; Wong, W. Douglas; Greene, Frederick L.; Leong, Stanley P L; Ross, Merrick I.

In: Annals of Surgery, Vol. 240, No. 4, 10.2004, p. 624-630.

Research output: Contribution to journalArticle

Bertagnolli, M, Miedema, B, Redston, M, Dowell, J, Niedzwiecki, D, Fleshman, J, Bem, J, Mayer, R, Zinner, M, Compton, C, Wong, WD, Greene, FL, Leong, SPL & Ross, MI 2004, 'Sentinel node staging of resectable colon cancer: Results of a multicenter study', Annals of Surgery, vol. 240, no. 4, pp. 624-630. https://doi.org/10.1097/01.sla.0000140753.41357.20
Bertagnolli M, Miedema B, Redston M, Dowell J, Niedzwiecki D, Fleshman J et al. Sentinel node staging of resectable colon cancer: Results of a multicenter study. Annals of Surgery. 2004 Oct;240(4):624-630. https://doi.org/10.1097/01.sla.0000140753.41357.20
Bertagnolli, Monica ; Miedema, Brent ; Redston, Mark ; Dowell, Jeannette ; Niedzwiecki, Donna ; Fleshman, James ; Bem, Jiri ; Mayer, Robert ; Zinner, Michael ; Compton, Carolyn ; Wong, W. Douglas ; Greene, Frederick L. ; Leong, Stanley P L ; Ross, Merrick I. / Sentinel node staging of resectable colon cancer : Results of a multicenter study. In: Annals of Surgery. 2004 ; Vol. 240, No. 4. pp. 624-630.
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abstract = "Objective and Summary Background Data: Sentinel lymph node (LN) sampling, a technique widely used to manage breast cancer and melanoma, seeks to select LNs that accurately predict regional node status and can be extensively examined to identify nodal metastatic disease not detected by standard histopathological staging. For patients with resectable colon cancer, improved identification of LN disease would significantly advance patient care by identifying patients likely to benefit from adjuvant therapy. This study, conducted by 25 surgeons at 13 institutions, examined whether sentinel node (SN) sampling accurately predicted LN status for patients with resectable colon cancer. Methods: SN sampling involved peritumor injection of 1{\%} isosulfan blue, followed by identification of all LN visualized within 10 minutes. SN sampling was performed on 79 of 91 patients enrolled, followed by multilevel sectioning (MLS) of the nodes and examination by a single study pathologist. Results: By standard histopathology, 7 patients had primary disease that was either benign or not colon cancer and were therefore excluded from further studies. Of 72 colon cancer cases studied, 48 (66{\%}) were node-negative and 24 (33{\%}) contained nodal metastases. SNs were successfully located in 66 cases (92{\%}), with an average of 2.1 nodes per patient. SNs were negative in 14 of 24 node-positive cases (58{\%}). MLS revealed tumor in a SN in 1 of these cases, bringing the false-negative rate of SN examination to 54{\%}. Conclusion: This multi-institutional study found that for patients with node-positive colon cancer, SN examination with MLS failed to predict nodal status in 54{\%} of cases. We conclude that SN sampling with MLS, used alone, is unlikely to improve risk stratification for resectable colon cancer.",
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AU - Miedema, Brent

AU - Redston, Mark

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AU - Niedzwiecki, Donna

AU - Fleshman, James

AU - Bem, Jiri

AU - Mayer, Robert

AU - Zinner, Michael

AU - Compton, Carolyn

AU - Wong, W. Douglas

AU - Greene, Frederick L.

AU - Leong, Stanley P L

AU - Ross, Merrick I.

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N2 - Objective and Summary Background Data: Sentinel lymph node (LN) sampling, a technique widely used to manage breast cancer and melanoma, seeks to select LNs that accurately predict regional node status and can be extensively examined to identify nodal metastatic disease not detected by standard histopathological staging. For patients with resectable colon cancer, improved identification of LN disease would significantly advance patient care by identifying patients likely to benefit from adjuvant therapy. This study, conducted by 25 surgeons at 13 institutions, examined whether sentinel node (SN) sampling accurately predicted LN status for patients with resectable colon cancer. Methods: SN sampling involved peritumor injection of 1% isosulfan blue, followed by identification of all LN visualized within 10 minutes. SN sampling was performed on 79 of 91 patients enrolled, followed by multilevel sectioning (MLS) of the nodes and examination by a single study pathologist. Results: By standard histopathology, 7 patients had primary disease that was either benign or not colon cancer and were therefore excluded from further studies. Of 72 colon cancer cases studied, 48 (66%) were node-negative and 24 (33%) contained nodal metastases. SNs were successfully located in 66 cases (92%), with an average of 2.1 nodes per patient. SNs were negative in 14 of 24 node-positive cases (58%). MLS revealed tumor in a SN in 1 of these cases, bringing the false-negative rate of SN examination to 54%. Conclusion: This multi-institutional study found that for patients with node-positive colon cancer, SN examination with MLS failed to predict nodal status in 54% of cases. We conclude that SN sampling with MLS, used alone, is unlikely to improve risk stratification for resectable colon cancer.

AB - Objective and Summary Background Data: Sentinel lymph node (LN) sampling, a technique widely used to manage breast cancer and melanoma, seeks to select LNs that accurately predict regional node status and can be extensively examined to identify nodal metastatic disease not detected by standard histopathological staging. For patients with resectable colon cancer, improved identification of LN disease would significantly advance patient care by identifying patients likely to benefit from adjuvant therapy. This study, conducted by 25 surgeons at 13 institutions, examined whether sentinel node (SN) sampling accurately predicted LN status for patients with resectable colon cancer. Methods: SN sampling involved peritumor injection of 1% isosulfan blue, followed by identification of all LN visualized within 10 minutes. SN sampling was performed on 79 of 91 patients enrolled, followed by multilevel sectioning (MLS) of the nodes and examination by a single study pathologist. Results: By standard histopathology, 7 patients had primary disease that was either benign or not colon cancer and were therefore excluded from further studies. Of 72 colon cancer cases studied, 48 (66%) were node-negative and 24 (33%) contained nodal metastases. SNs were successfully located in 66 cases (92%), with an average of 2.1 nodes per patient. SNs were negative in 14 of 24 node-positive cases (58%). MLS revealed tumor in a SN in 1 of these cases, bringing the false-negative rate of SN examination to 54%. Conclusion: This multi-institutional study found that for patients with node-positive colon cancer, SN examination with MLS failed to predict nodal status in 54% of cases. We conclude that SN sampling with MLS, used alone, is unlikely to improve risk stratification for resectable colon cancer.

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