In this study, the efficacy of sentinel lymph node mapping in patients diagnosed with adenocarcinoma of the colon cancer and an algorithm to predict a possible survival advantage using sentinel lymph node mapping and lymph node ultra-examination techniques favor of the best-case estimates are developed.
Methodology:
41 patients with adenocarcinoma of the colon carcinoma, who underwent a colectomy with curative intent, were studied prospectively. After mobilization of adenocarcinoma of the colon and mesentery were injected with 1-2 ml of the dye Isosulfanblau subserosa around the tumor. The first blue-stained lymph nodes were identified as sentinel nodes (sentinel node). Additional nodes were detected by the pathologist routinely by manual dissection of the mesentery. All nodes were processed routinely by histological examination with hematoxylin-eosin staining. To develop an algorithm to predict the possible survival advantage by sentinel node mapping and lymph node ultra-examination techniques, assumptions have been postulated on the basis of literature data. Any tendency was focused on the success of the techniques.
Results:
Three out of 41 patients (7%) no color was injected and they were excluded from further analysis. The clinical stage of the remaining 38 patients, distributed as follow: stage I: n = 10 (26%), stage II: n = 15 (39%), stage III: n = 11 (29%), stage IV: n = 2 (5%). At least one sentinel node was identified in 30 of 38 patients (79%). The mean number of detected sentinel node was two (range one to three). The mean total number of recovered lymph nodes was 14 (range seven to 45). In 26 of 38 patients (68%) of all nodes were negative. Sentinel nodes were positive and Nonsentinel nodes in two of 38 patients (5%). One of every 38 patients (3%) was sentinel nodes are the only positive lymph nodes. In nine of 38 patients (24%) were sentinel node negative and node positive Nonsentinel. Consequently, sentinel node mapping was only 3% might have been useful, but failed in 24% of patients in our study of the precise detection of lymph node metastases. To develop an algorithm to calculate the survival benefit, we found the following assumptions: a combination of disease stage I and II (0.5), proportion of the material that has been at the classified by using histologic examination with hematoxylin-eosin staining, the stage was too low and could be included in the more differentiated analysis of hidden nodes positive (0.15), number of occult positive nodes were detected by sentinel lymph node mapping (0.9), and survival benefit of chemotherapy (0.33). That would mean the proportion of patients who benefit from sentinel lymph node mapping and lymph node ultra-examination techniques, at 0.02 (2%).
Conclusions:
Sentinel node mapping with isosulfan blue staining and routine processing of removed nodes improves the accuracy of staging in patients with adenocarcinoma of the colon cancer is not. Even when using best-case assumptions, the percentage of patients who could potentially benefit from sentinel lymph node mapping, small.
Purpose:
This study was designed to: determine the efficacy of sentinel lymph node mapping in patients with adenocarcinoma of the colon cancer, and create an algorithm to predict potential survival benefit by using best-case estimates in favor of sentinel node mapping and lymph node ultra-processing techniques.
Methods:
Forty-one patients with adenocarcinoma of the colon cancer with curative intent undergoing colectomy were studied prospectively. After mobilization of the colon and Mesentery, 1 to 2 mL of isosulfan blue dye around the tumor was injected subserosally. The first several nodes highlighted with blue dye was identified as sentinel nodes. Additional nodes were identified by the pathologist in routine fashion by manual dissection of the Mesentery. All nodes were processed in routine fashion by hematoxylin and eosin staining and bivalving. To create an algorithm to predict potential survival benefit of sentinel node mapping and lymph node ultra-processing techniques, assumptions were made using data from the literature. All bias directed toward that success of the techniques.
Results:
Three of 41 patients (7 percent) did not undergo injection of dye and were excluded from further analysis. Stage of disease in the remaining 38 patients was: I, n = 10 (26 percent), II, n = 15 (39 percent), III, n = 11 (29 percent), IV, n (percent 5) = 2. At least one sentinel node was identified in 30 of 38 patients (79 percent). The median amount of sentinel nodes identified was two (range, 1-3). Median total nodal retrieval was 14 (range, 7-45). All nodes were negative in 26 of 38 patients (68 percent). Sentinel nodes and nonsentinel nodes were positive in 2 of 38 patients (5 percent). Sentinel nodes were the only positive nodes in 1 of 38 patients (3 percent). Sentinel nodes were negative and highly developed nonsentinel nodes were positive in 9 of 38 patients (24 percent). Thus, sentinel node mapping would have potentially benefited only 3 percent, and failed accurately to identify nodal metastases in 24 percent of the patients in our study. To create a survival benefit algorithm, we assumed the following: combined fraction of stage I and II disease (0.5), fraction under taged by bivalving and hematoxylin and eosin staining that would have occult positive nodes by more sophisticated analysis (0.15); fraction of occult positive nodes detected by sentinel node mapping (0.9), and survival benefit from chemotherapy (0.33). Thus, the fraction of patients benefiting from sentinel lymph node mapping and lymph node ultra-processing techniques would be 0.02 (percent 2).
Conclusions:
Sentinel node mapping with isosulfan blue dye and routine processing of retrieved nodes does not improve staging accuracy in patients with adenocarcinoma of the colon cancer, Even using best-case assumptions, the percentage of patients who would potentially benefit from sentinel lymph node mapping is small.
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