Wood T F, Saha S, Morton D L, Tsioulias G J, Rangel D, Hutchinson W, Foshag L J, Bilchik A J
John Wayne Cancer Institute, Santa Monica, California 90404, USA.
Ann Surg Oncol. 2001 Mar;8(2):150-7. doi: 10.1007/s10434-001-0150-1.
The use of lymphatic mapping (LM) is being investigated to improve the staging of colorectal cancer (CRC) and thereby identify patients who might benefit from adjuvant chemotherapy. This study evaluated in vivo, laparoscopic, and ex vivo approaches for the ultrastaging of CRC.
Seventy-five CRC patients were enrolled in a study of LM with peritumoral injection of isosulfan blue dye. LM was undertaken during open colon resection (OCR) in 64 patients, during laparoscopic colon resection (LCR) in 9 patients, and after specimen removal (ex vivo) in 2 patients. Ex vivo LM was also undertaken in 6 patients after unsuccessful in vivo LM. All nodes were examined by hematoxylin and eosin (H&E) staining; in addition, sentinel lymph nodes (SNs) were multisectioned and examined by immunohistochemical staining with cytokeratin (CK-IHC).
At least one SN was identified in 72 patients (96%). In vivo LM identified SNs in 56 of 64 (88%) patients undergoing OCR and in 9 of 9 (100%) patients undergoing LCR. Ex vivo LM was undertaken as the initial mapping procedure in 2 cases of intraperitoneal colon cancer and after in vivo LM had failed in 6 cases of extraperitoneal rectal carcinoma; an SN was identified in 7 of the 8 cases. Focused examination of the SN correctly predicted nodal status in 53 of 56 OCR cases, 9 of 9 LCR cases, and 6 of 7 ex vivo cases. Multiple sections and CK-IHC identified occult micrometastases in 13 patients (17%), representing 10 OCR, 1 LCR, and 2 ex vivo cases.
LM of drainage from a primary CRC can be accurately performed in vivo during OCR or LCR. Ex vivo LM can be applied when in vivo techniques are unsuccessful and may be useful for rectal tumors. During LCR, colonoscopic injection can be used to mark the primary tumor and define the lymphatic drainage so that adequate resection margins are obtained. These LM techniques improve staging accuracy in CRC.
正在研究使用淋巴绘图（LM）来改善结直肠癌（CRC）的分期，从而识别可能从辅助化疗中获益的患者。本研究评估了CRC超分期的体内、腹腔镜和体外方法。
75例CRC患者纳入一项经瘤周注射异硫蓝染料的LM研究。64例患者在开放结肠切除术（OCR）期间进行LM，9例患者在腹腔镜结肠切除术（LCR）期间进行LM，2例患者在标本切除后（体外）进行LM。6例体内LM失败的患者也进行了体外LM。所有淋巴结均通过苏木精和伊红（H&E）染色检查；此外，对前哨淋巴结（SNs）进行多切片，并通过细胞角蛋白免疫组织化学染色（CK-IHC）检查。
72例患者（96%）至少识别出一个SN。体内LM在64例接受OCR的患者中的56例（88%）和9例接受LCR的患者中的9例（100%）中识别出SN。体外LM在2例腹膜内结肠癌中作为初始绘图程序进行，在6例腹膜外直肠癌体内LM失败后进行；8例中的7例识别出一个SN。对SN的重点检查在56例OCR病例中的53例、9例LCR病例中的9例和7例体外病例中的6例中正确预测了淋巴结状态。多切片和CK-IHC在13例患者（17%）中识别出隐匿性微转移，分别代表10例OCR、1例LCR和2例体外病例。
在OCR或LCR期间，可以在体内准确地进行原发性CRC引流的LM。当体内技术不成功时，可以应用体外LM，这可能对直肠肿瘤有用。在LCR期间，可使用结肠镜注射标记原发性肿瘤并确定淋巴引流，以便获得足够的切除边缘。这些LM技术提高了CRC的分期准确性。
