Annals of Coloproctology

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Sentinel Lymph Node Analysis in Colorectal Cancer Patients Using One-Step Nucleic Acid Amplification in Combination With Fluorescence and Indocyanine Green: Francesco Esposito, Adele Noviello, Nicola Moles, Enrico Coppola Bottazzi, Mario Baiamonte, Ina Macaione, Umberto Ferbo, Maria Lepore, Antonio Miro, Francesco Crafa; Ann Coloproctol. 2019;35(4):174-180. Published online August 31, 2019; DOI: https://doi.org/10.3393/ac.2018.07.21.1

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Purpose
Analysis of the sentinel lymph node (SLN) in colorectal cancer (CRC) patients was proposed for more accurate staging and tailored lymphadenectomy. The aim of this study was to assess the ability to predict lymph node (LN) involvement through analysis of the SLN with a one-step nucleic acid (OSNA) technique in combination with peritumoral injection of indocyanine green (ICG) and near-infrared (NIR) lymphangiography in CRC patients.
Methods
A total of 34 patients were enrolled. Overall, 51 LNs were analyzed with OSNA. LNs of 17 patients (50%) were examined simultaneously with hematoxylin and eosin (H&E) and OSNA.
Results
SLN analysis of 17 patients examined with H&E and OSNA revealed that OSNA had a higher sensitivity (1 vs. 0.55), higher negative predictive value (1 vs. 0.66) and higher accuracy (100% vs. 76.4%) in predicting LN involvement. Overall, OSNA showed a sensitivity of 0.69, specificity of 1, accuracy of 88.2%, and stage migration of 8.8%. Compared to those who were OSNA (−), OSNA (+) patients had a greater number of LN metastases (4.8 vs. 0.16, P = 0.04), higher G3 rate (44.4% vs. 4%, P = 0.01), more advanced stage of disease (stage III: 77.8% vs. 16%; P = 0.00) and were more rapidly subjected to adjuvant chemotherapy (39.1 days vs. 50.2 days, P = 0.01).
Conclusion
SLN analysis with OSNA in combination with ICG-NIR lymphangiography is feasible and can detect LN involvement in CRC patients. Furthermore, it allows for more accurate staging reducing the delay between surgery and adjuvant chemotherapy.

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Diagnostic value of one-step nucleic acid amplification for sentinel lymph node metastasis in cytokeratin 19-positive tumors: evidence from bioinformatics and meta-analysis
Ke Li, Min Meng, Weiwei Zhang, Junyi Li, Yiting Wang, Changhui Zhou
Frontiers in Oncology.2024;[Epub] CrossRef
Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors: Personal experience and literature review
Francesco Crafa, Serafino Vanella, Aristide Morante, Onofrio A Catalano, Kelsey L Pomykala, Mario Baiamonte, Maria Godas, Alexandra Antunes, Joaquim Costa Pereira, Valentina Giaccaglia
World Journal of Gastroenterology.2023; 29(24): 3883. CrossRef
Role of one-step nucleic acid amplification in colorectal cancer lymph node metastases detection
Francesco Crafa, Serafino Vanella, Onofrio A Catalano, Kelsey L Pomykala, Mario Baiamonte
World Journal of Gastroenterology.2022; 28(30): 4019. CrossRef
Mapping Lymph Node during Indocyanine Green Fluorescence-Imaging Guided Gastric Oncologic Surgery: Current Applications and Future Directions
Yiqun Liao, Jiahao Zhao, Yuji Chen, Bin Zhao, Yongkun Fang, Fei Wang, Chen Wei, Yichao Ma, Hao Ji, Daorong Wang, Dong Tang
Cancers.2022; 14(20): 5143. CrossRef
The advantage of one‐step nucleic acid amplification for the diagnosis of lymph node metastasis in colorectal cancer patients
Yukiharu Hiyoshi, Takashi Akiyoshi, Yosuke Fukunaga
Annals of Gastroenterological Surgery.2021; 5(1): 60. CrossRef
The evolving role of one-step nucleic acid amplification (OSNA) for the intra-operative detection of lymph node metastases: A diagnostic accuracy meta-analysis
Anastasios Tranoulis, Dimitra Georgiou, Jason Yap, Stephen Attard-Montalto, Jeremy Twigg, Ahmed Elattar, Kavita Singh, Janos Balega, Sean Kehoe
European Journal of Surgical Oncology.2021; 47(6): 1233. CrossRef

The Feasibility of an Ex-vivo Sentinel Lymph Mapping Using Preoperative Radioisotope Injection in Cases of Extraperitoneal Rectal Cancer: Jun Seok Park, Gyu-Seog Choi, Hye Jin Kim, Soo Yeon Park, Yun Jung Park, Sang-Woo Lee, Ziguang Xu, Han Ik Bae; J Korean Soc Coloproctol. 2011;27(2):83-89. Published online April 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.2.83

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Abstract PDF

Purpose

The purpose of this research was to evaluate the feasibility of sentinel lymph node (SLN) mapping involving transanal injection with an ex-vivo mapping in patients with rectal cancer.

Methods

Between April 2007 and December 2009, 20 consecutive patients with T1-3, N0-1 clinical stage rectal cancer preoperatively underwent a SLN procedure using submucosal ^99mTc-phytate injection. All the patients underwent a total mesorectal excision. After the standard surgical resection, all specimens were identified on lymphoscintigraphy, and bench work was done to pick up the sentinel node basin. All the lymph nodes (non-SLNs and SLNs) were examined using conventional hematoxylin and eosin staining and immunohistochemistry with anti-cytokeratin antibodies.

Results

SLNs were identified from 19 of 20 patients with rectal cancer. The total number of sentinel nodes retrieved from the surgical specimens was 29, and the mean number per patient was 1.6 (range, 0 to 4). In three patients, the SLN was the only positive lymph node. There was one false-negative case with a sensitivity of 88.8% and two upstaged cases (20.0%). The SLN samples from rectal cancer are mainly localized in the pararectal region, but aberrant nodes receive direct drainage from the rectal cancer. On planar lymphoscintigraphy, 15.7% of all patients had aberrant lymphatic drainage to the sigmoid mesenteric or sigmoid lymph node station.

Conclusion

In conclusion, the intraoperative transanal injection for ex-vivo SLN navigation is a safe, feasible surgical modality in patients with rectal cancer. Large studies are warranted to determine the clinical significance of the SLN concept and micrometastasis in rectal cancer.

Citations

Citations to this article as recorded by

Comparing the efficacy of routine H&E staining and cytokeratin immunohistochemical staining in detection of micro-metastasis on serial sections of dye-mapped sentinel lymph nodes in colorectal carcinoma
Mohammad Hossein Sanei, Seid Abbas Tabatabie, Seid Mozafar Hashemi, Ali Cherei, Parvin Mahzouni, Behnam Sanei
Advanced Biomedical Research.2016;[Epub] CrossRef
In vivo lymph node mapping and pattern of metastasis spread in locally advanced mid/low rectal cancer after neoadjuvant chemoradiotherapy
E. Farinella, L. Viganò, M. C. Fava, M. Mineccia, F. Bertolino, L. Capussotti
International Journal of Colorectal Disease.2013; 28(11): 1523. CrossRef
A rectumtumorok sebészete
Péter Metzger
Magyar Sebészet.2012; 65(3): 129. CrossRef

Ex-vivo Sentinel Lymph-node Mapping in Colorectal Cancer.: Kim, Hyung Jin , Lee, In Kyu , Lee, Yoon Suk , Kang, Won Kyung , Ahn, Chang Hyeok , Oh, Seong Taek; J Korean Soc Coloproctol. 2008;24(1):39-44.; DOI: https://doi.org/10.3393/jksc.2008.24.1.39

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Abstract PDF: PURPOSE
The presence of lymph-node metastases is one of the most important prognostic factors for patients with a colorectal carcinoma. The sentinel lymph node is the first lymph node that receives afferent lymphatic drainage from a primary tumor, and thus has the highest risk of harboring metastatic disease. METHODS: Twenty-eight patients with an adenocarcinoma of the colon or the rectum were investigated. After resection of the specimen in standard oncologic fashion, the specimen was dissected longitudinally along the antimesenteric border, and methylene blue was injected around the tumor submucosally. After 5 minutes, the mesentery was meticulously examined, and blue-stained lymphatics and lymph nodes were carefully dissected and harvested. RESULTS: Sentinel lymph nodes were identified in all cases. The average number of sentinel nodes identified was 3 (range, 1~6), and the average number of lymph nodes retrieved was 20.8 (range, 6~42). Of the fifteen patients (53.6%) identified to be positive for lymph-node metastasis 10 showed nonsentinel nodal metastasis without sentinel nodal involvement. No additional isolated tumor cells were found by immunohistochemical staining in 13 patients who had no lymph-node metastasis on conventional pathologic examination. CONCLUSIONS: In colorectal cancer, the sentinel-lymph-node sampling method is easy and can be performed for the purpose of finding lymph nodes easily. However, applying the sentinel-lymph-node sampling method for the purpose of minimizing lymph node dissection, as in breast cancer, is not recommended because of the high probability of missing metastasis.

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