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Sentinel Node Biopsy for the Individualization of Surgical Strategy for Cure of Early-Stage Colon Cancer
- Source :
- Annals of Surgical Oncology. 16:2170-2180
- Publication Year :
- 2009
- Publisher :
- Springer Science and Business Media LLC, 2009.
-
Abstract
- 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.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.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 contributing22 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).These findings support the further investigation of SNB as oncological augment for localized resective techniques. Specific prospective study should pursue this goal.
- Subjects :
- Male
medicine.medical_specialty
Stage colon cancer
Surgical strategy
Colorectal cancer
Surgical oncology
Biopsy
medicine
Humans
Endoscopic resection
Prospective Studies
Aged
Neoplasm Staging
medicine.diagnostic_test
Sentinel Lymph Node Biopsy
business.industry
General surgery
Natural orifice transluminal endoscopic surgery
Middle Aged
Sentinel node
Prognosis
medicine.disease
Surgery
Oncology
Colonic Neoplasms
Female
Lymph Nodes
business
Subjects
Details
- ISSN :
- 15344681 and 10689265
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- Annals of Surgical Oncology
- Accession number :
- edsair.doi.dedup.....74cc8ee8b6585f1e5e2d864224b1f367