Fitzgerald T L, Khalifa M A, Al Zahrani M, Law C H L, Smith A J
Division of Surgical Oncology and Department of Pathology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto and Toronto-Sunnybrook Regional Cancer Centre.
J Surg Oncol. 2002 May;80(1):27-32; discussion 33. doi: 10.1002/jso.10091.
Sentinel lymph node (SLN) biopsy may improve staging of colorectal cancer. We tested the feasibility of ex vivo SLN dissection.
Patients undergoing resection of a primary colorectal cancer were included in this study. SLN identification involved ex vivo injection of 1 cc isosulfan blue dye subserosally in the colon or submucosally in the rectum on a separate field. SLNs were cut at 2 mm intervals. Three hematoxylin and eosin-stained (HE) sections were prepared in addition to a middle level for cytokeratin immunostaining.
Twenty-six patients with varying tumor location and stage were enrolled and the SLN was identified in 88% (23/26) cases. Three failures occurred in patients with rectal cancer. The average number of SLN harvested was 2.5. The status of the nodal basin was accurately predicted in 91% (21/23) of patients. Two false negative sentinel lymph nodes were harvested in 2 of 3 patients with stage III/IV colorectal cancer. The SLN upstaged 2 patients as a result of HE stained step sections (n = 1) and immunostaining (n = 1).
This data suggests that ex vivo SLN biopsy is feasible in colorectal cancer. Although ex vivo SLN biopsy does not alter the lymphatic dissection, it may upstage a subset of patients. The ex vivo technique may be less applicable in rectal cancer and false negative results may occur.
前哨淋巴结（SLN）活检可能会改善结直肠癌的分期。我们测试了体外SLN解剖的可行性。
本研究纳入了接受原发性结直肠癌切除术的患者。SLN的识别包括在单独区域于结肠浆膜下或直肠黏膜下体外注射1毫升异硫蓝染料。将SLN以2毫米的间隔切开。除了制备用于细胞角蛋白免疫染色的中间水平切片外，还制备了三张苏木精和伊红染色（HE）切片。
纳入了26例肿瘤位置和分期各异的患者，88%（23/26）的病例中识别出了SLN。直肠癌患者中有3例未成功识别。平均收获的SLN数量为2.5个。91%（21/23）的患者中淋巴结区域的状态被准确预测。3例III/IV期结直肠癌患者中有2例收获了2个假阴性前哨淋巴结。由于HE染色连续切片（n = 1）和免疫染色（n = 1），SLN使2例患者分期上调。
该数据表明体外SLN活检在结直肠癌中是可行的。尽管体外SLN活检不会改变淋巴结清扫，但它可能会使一部分患者分期上调。体外技术在直肠癌中可能不太适用，并且可能会出现假阴性结果。
