Department of Surgery, Section of Colon and Rectal Surgery, Barnes-Jewish Hospital, St Louis, Missouri 63110, USA.
Dis Colon Rectum. 2010 Mar;53(3):243-50. doi: 10.1007/DCR.0b013e3181c3822b.
Controversy exists over the utility of sentinel lymph node mapping in the treatment of rectal cancer. The purpose of this study was to evaluate the use of ex vivo sentinel lymph node mapping in the setting of proctectomy for rectal cancer, with and without multilevel sectioning and immunohistochemistry.
A prospective phase 2 clinical study of subjects undergoing proctectomy for rectal cancer from 2003 to 2008 was conducted. Sentinel lymph node mapping was performed with ex vivo injection of isosulfan blue. Sentinel lymph nodes were examined by hematoxylin and eosin evaluation, and when the results were negative, they were examined by multilevel sectioning and immunohistochemistry.
The study population consisted of 58 subjects; 88% received neoadjuvant therapy. Tumors were downstaged in 25 (49%) subjects receiving neoadjuvant therapy, 24% were clinical complete responders, and 20% were pathologic complete responders. The mean total lymph node harvest was 12.1 nodes per patient. Twenty-five subjects had positive nodal disease on final pathology. The sentinel lymph node detection rate was 85%, with a mean sentinel lymph node harvest of 2.2 nodes per subject. Fifteen (26%) subjects had sentinel lymph node nodal metastasis on routine hematoxylin and eosin examination. Neither multilevel sectioning nor immunohistochemistry evaluation improved detection of sentinel lymph node positivity. The accuracy of sentinel lymph node mapping was 71%, the sensitivity was 53%, the negative predictive value was 79%, and the false negative rate was 47%. Seven subjects were determined to have nodal disease only in the sentinel lymph node.
Ex vivo sentinel lymph node mapping is feasible after proctectomy for rectal cancer but did not improve staging. Neither multilevel sectioning nor immunohistochemistry improved the sensitivity of sentinel lymph node mapping.
在直肠癌的治疗中，前哨淋巴结（SLN）作图的实用性存在争议。本研究旨在评估在直肠切除术中进行 SLN 作图的用途，包括是否进行多层切片和免疫组织化学检查。
对 2003 年至 2008 年间接受直肠切除术的直肠癌患者进行了前瞻性的 2 期临床研究。使用异硫蓝进行体外 SLN 注射进行 SLN 作图。苏木精和伊红评估 SLN，如果结果为阴性，则进行多层切片和免疫组织化学检查。
该研究人群包括 58 例患者；88%接受了新辅助治疗。接受新辅助治疗的患者中有 25 例（49%）肿瘤降期，24%为临床完全缓解者，20%为病理完全缓解者。平均总淋巴结采集量为每位患者 12.1 个。25 例患者最终病理有阳性淋巴结转移。SLN 检出率为 85%，平均每位患者检出 2.2 个 SLN。15 例（26%）患者在常规苏木精和伊红检查中发现 SLN 淋巴结转移。多层切片和免疫组织化学检查均未提高 SLN 阳性检出率。SLN 作图的准确性为 71%，灵敏度为 53%，阴性预测值为 79%，假阴性率为 47%。7 例患者仅在 SLN 中发现淋巴结疾病。
在直肠切除术后进行体外 SLN 作图是可行的，但并未改善分期。多层切片和免疫组织化学检查均未提高 SLN 作图的灵敏度。
