Sentinel node biopsy for the individualization of surgical strategy for cure of early-stage colon cancer.
Ann Surg Oncol
; 16(8): 2170-80, 2009 Aug.
Article
em En
| MEDLINE
| ID: mdl-19472012
ABSTRACT
INTRODUCTION:
The requirement for nodal analysis currently confounds the oncological propriety of focused purely endoscopic resection for early-stage colon cancer and complicates the evolution of innovative alternatives such as natural orifice transluminal endoscopic surgery (NOTES) and its hybrids. Adjunctive sentinel node biopsy (SNB) deserves consideration as a means of addressing this shortfall.METHODS:
Data from two prospectively maintained databases established for multicentric studies of SNB in colon cancer that employed similar methodologies were pooled to establish technique potency selectively in T1/T2 disease (both overall and under optimized conditions) and to project potential clinical impact.RESULTS:
Of 891 patients with T1-4, M0 intraperitoneal colon cancer, 225 had T1/T2 disease. Sentinel nodes were either not found or were falsely negative in 18 patients with T1/T2 cancers (8%) as compared with 17% (112/646) in those with T3/T4 disease (P = 0.001). Negative predictive value (NPV) in the former exceeded 95%, while sensitivity [including immunohistochemistry (IHC)] was 81%. In the 193 patients with T1/T2 disease recruited from those centers contributing >22 patients, sensitivity was 89% and NPV 97%. Thus, in this cohort, SNB could have correctly prompted localized resection (obviating en bloc mesenteric dissection) in 75% (144) of patients, including 59 with T1 lesions potentially amenable to intraluminal resection alone as their definitive treatment. Forty-four patients (23.4%) would still have conventional resection, leaving three patients (1.6% overall) understaged (11% false-negative rate).CONCLUSION:
These findings support the further investigation of SNB as oncological augment for localized resective techniques. Specific prospective study should pursue this goal.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Neoplasias do Colo
/
Biópsia de Linfonodo Sentinela
/
Linfonodos
Idioma:
En
Ano de publicação:
2009
Tipo de documento:
Article