Weixler Benjamin, Rickenbacher Andreas, Raptis Dimitri Aristotle, Viehl Carsten T, Guller Ulrich, Rueff Jessica, Zettl Andreas, Zuber Markus
Department of Surgery, University Hospital Basel, Basel, Switzerland.
Department of Surgery, Kantonsspital Olten, 4600, Olten, Switzerland.
World J Surg. 2017 Sep;41(9):2378-2386. doi: 10.1007/s00268-017-4051-2.
Sentinel lymph node (SLN) mapping was reported to improve lymph node staging in colon cancer. This study compares isosulfan blue (IB) with indocyanine green (ICG)-based SLN-mapping and assesses the prognostic value of isolated tumor cells (ITC) and micro-metastases in upstaged patients.
A total of 220 stage I-III colon cancer patients were included in this prospective single-center study. In 170 patients, SLN-mapping was performed in vivo with IB and in 50 patients ex vivo with ICG. Three levels of each SLN were stained with H&E. If negative for tumor infiltration, immunostaining for cytokeratin (AE1/3; cytokeratin-19) was performed.
SLN detection rate for IB and ICG was 100 and 98%, respectively. Accuracy and sensitivity was 88 and 75% for IB, 82 and 64% for ICG, respectively (p = 0.244). Overall, 149 (68%) patients were node negative. In these patients, ITC and micro-metastases were detected in 26% (31/129) with IB and 17% (5/29) with ICG (p = 0.469). Patients with ITC and micro-metastases did show decreased overall survival (hazard ratio = 1.96, p = 0.09) compared to node negative disease.
This study demonstrates a high diagnostic accuracy for both the IB and the ICG SLN-mapping. SLN-mapping upstaged a quarter of patients with node negative colon cancer, and the detected ITC and micro-metastases were an independent negative prognostic marker in multivariate analysis.
据报道，前哨淋巴结（SLN）定位可改善结肠癌的淋巴结分期。本研究比较了异硫蓝（IB）与基于吲哚菁绿（ICG）的SLN定位，并评估了分期上调患者中孤立肿瘤细胞（ITC）和微转移的预后价值。
本前瞻性单中心研究共纳入220例I-III期结肠癌患者。170例患者采用IB进行体内SLN定位，50例患者采用ICG进行体外SLN定位。每个SLN的三个层面用苏木精和伊红（H&E）染色。如果肿瘤浸润为阴性，则进行细胞角蛋白（AE1/3；细胞角蛋白-19）免疫染色。
IB和ICG的SLN检出率分别为100%和98%。IB的准确率和灵敏度分别为88%和75%，ICG的准确率和灵敏度分别为82%和64%（p = 0.244）。总体而言，149例（68%）患者淋巴结阴性。在这些患者中，IB组26%（31/129）检测到ITC和微转移，ICG组17%（5/29）检测到ITC和微转移（p = 0.469）。与淋巴结阴性疾病相比，ITC和微转移患者的总生存期确实缩短（风险比 = 1.96，p = 0.09）。
本研究表明，IB和ICG SLN定位均具有较高的诊断准确性。SLN定位使四分之一淋巴结阴性的结肠癌患者分期上调，且检测到的ITC和微转移在多变量分析中是独立的不良预后标志物。
