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Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Colitis/diagnosis , Cysts/diagnosis , Gastrointestinal Hemorrhage/etiology , Intestinal Mucosa/pathology , Rectal Neoplasms/diagnosis , Diagnosis, Differential , Follow-Up StudiesABSTRACT
Introducción El estudio de los ganglios linfáticos supone el factor pronóstico más importante en el cáncer colorrectal sin metástasis. La técnica del ganglio centinela identifica el ganglio que mejor predice el estado ganglionar de un paciente y permite realizar en él técnicas de estudio intensivo que mejoran la estadificación. El objetivo del trabajo es estudiar la eficacia de la técnica del ganglio centinela en la estadificación del cáncer de colon.Material y métodos Estudio prospectivo con 125 pacientes diagnosticados preoperatoriamente de cáncer de colon sin metástasis a distancia desde septiembre de 2009 hasta diciembre de 2011 en el Hospital Universitario de Álava-Txagorritxu en Álava. Realizamos la técnica del ganglio centinela ex vivo y con azul de metileno. El ganglio centinela se estudió realizando secciones múltiples y técnicas de inmunohistoquímica, además de hematoxilina-eosina. Realizamos un estudio comparativo con un grupo control con 170 pacientes estudiado de forma convencional mediante sección única y tinción de hematoxilina-eosina. Resultados Identificamos el ganglio centinela en el 98% de los casos, con una tasa de falsos negativos del 5,6%. La supraestadificación lograda en el grupo con estudio del ganglio centinela se encuentra en el 14,2% con respecto al grupo estudiado convencionalmente (p = 0,006).Conclusiones El estudio del ganglio centinela realizado ex vivo y con azul de metileno predice el estado ganglionar de los pacientes con cáncer de colon. Esta técnica supraestadifica, pasando al estadio iii a pacientes que el estudio convencional determinaba como estadios i y ii , permitiendo que accedan a un tratamiento quimioterápico que podría mejorar su pronóstico (AU)
Introduction The level of lymph node involvement is the most important factor in staging colorectal cancer without metastasis. Sentinel lymph node mapping identifies the node(s) that most accurately reflect the lymph node status of patients, and intensive techniques that improve staging can be focused on these nodes. The aim of this study was to assess the efficacy of ex vivo sentinel lymph node mapping in the staging of colon cancer. Materials and methods A prospective study was conducted on 125 patients from the Alava-Txagorritxu University Hospital Health Region (Alava), who were diagnosed prior to surgery with colon cancer without distant metastasis from September 2009 to December 2011. Ex vivo sentinel lymph node mapping with methylene blue was use in these patients to study the sentinel nodes with multiple slices using immunohistochemical techniques and haematoxylin-eosin staining. A comparative study was also performed based on a control group of 170 patients staged with conventional techniques, and involving a single slice and haematoxylin-eosin staining. Results The sentinel lymph node identification rate was 98%, with 5.6% false negatives. Upstaging occurred in 14.2% of cases compared to the group studied using conventional techniques (P=.006).Conclusions Ex vivo sentinel lymph node mapping with methylene blue accurately reflects the lymph node status of patients with colon cancer. This approach upstages patients classified as stages i and ii by conventional techniques to stage iii , indicating chemotherapy that may improve their prognosis (AU)
Subject(s)
Humans , Sentinel Lymph Node Biopsy/methods , Colonic Neoplasms/pathology , Colorectal Neoplasms/pathology , Lymphatic Metastasis/pathologyABSTRACT
INTRODUCTION: The level of lymph node involvement is the most important factor in staging colorectal cancer without metastasis. Sentinel lymph node mapping identifies the node(s) that most accurately reflect the lymph node status of patients, and intensive techniques that improve staging can be focused on these nodes. The aim of this study was to assess the efficacy of ex vivo sentinel lymph node mapping in the staging of colon cancer. MATERIALS AND METHODS: A prospective study was conducted on 125 patients from the Alava-Txagorritxu University Hospital Health Region (Alava), who were diagnosed prior to surgery with colon cancer without distant metastasis from September 2009 to December 2011. Ex vivo sentinel lymph node mapping with methylene blue was use in these patients to study the sentinel nodes with multiple slices using immunohistochemical techniques and haematoxylin-eosin staining. A comparative study was also performed based on a control group of 170 patients staged with conventional techniques, and involving a single slice and haematoxylin-eosin staining. RESULTS: The sentinel lymph node identification rate was 98%, with 5.6% false negatives. Upstaging occurred in 14.2% of cases compared to the group studied using conventional techniques (P=.006). CONCLUSIONS: Ex vivo sentinel lymph node mapping with methylene blue accurately reflects the lymph node status of patients with colon cancer. This approach upstages patients classified as stages i and ii by conventional techniques to stage iii, indicating chemotherapy that may improve their prognosis.