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TY - JOUR

T1 - Systematic Review of Sentinel Lymph Node Mapping Procedure in Colorectal Cancer

AU - van der Zaag, Edwin S.

AU - Bouma, Wim H.

AU - Tanis, Pieter J.

AU - Ubbink, Dirk T.

AU - Bemelman, Willem A.

AU - Buskens, Christianne J.

PY - 2012

Y1 - 2012

N2 - The clinical impact of sentinel lymph node (SN) biopsy in colorectal cancer is still controversial. The aim of our study was to determine the accuracy of this procedure from published data and to identify factors that contribute to the conflicting reports. A systematic search of the Medline, Embase, and Cochrane databases up to July 2011 revealed 98 potentially eligible studies, of which 57 were analyzed including 3,934 patients (3,944 specimens). The pooled SN identification rate was 90.7 % (95 % CI 88.2-93.3), with a significant higher identification rate in studies including more than 100 patients or studies using the ex vivo SN technique. The pooled sensitivity of the SN procedure was 69.6 % (95 % CI 64.7-74.6). Including the immunohistochemical findings increased the pooled sensitivity of SN procedure to 80.2 % (95 % CI 4.7-10.7). Subgroups with significantly higher sensitivity could be identified: a parts per thousand yen4 SNs versus <4 SNs (85.2 vs. 66.3 %, p = 0.003), colon versus rectal cancer (77.6 vs. 65.7 %, p = 0.04), early T1 or T2 versus advanced T3 or T4 carcinomas (93.4 vs. 58.8 %, p = 0.01). Serial sectioning and immunohistochemistry resulted in a mean upstaging of 18.9 % (range 0-50 %). True upstaging defined as micrometastases (pN1mi+) rather than isolated tumor cells (pN0itc+) was 7.7 %. The SN procedure in colorectal cancer has an overall sensitivity of 70 %, with increased sensitivity and refined staging in early-stage colon cancer. Because the ex vivo SN mapping is an easy technique it should be considered in addition to conventional resection in colon cancer

AB - The clinical impact of sentinel lymph node (SN) biopsy in colorectal cancer is still controversial. The aim of our study was to determine the accuracy of this procedure from published data and to identify factors that contribute to the conflicting reports. A systematic search of the Medline, Embase, and Cochrane databases up to July 2011 revealed 98 potentially eligible studies, of which 57 were analyzed including 3,934 patients (3,944 specimens). The pooled SN identification rate was 90.7 % (95 % CI 88.2-93.3), with a significant higher identification rate in studies including more than 100 patients or studies using the ex vivo SN technique. The pooled sensitivity of the SN procedure was 69.6 % (95 % CI 64.7-74.6). Including the immunohistochemical findings increased the pooled sensitivity of SN procedure to 80.2 % (95 % CI 4.7-10.7). Subgroups with significantly higher sensitivity could be identified: a parts per thousand yen4 SNs versus <4 SNs (85.2 vs. 66.3 %, p = 0.003), colon versus rectal cancer (77.6 vs. 65.7 %, p = 0.04), early T1 or T2 versus advanced T3 or T4 carcinomas (93.4 vs. 58.8 %, p = 0.01). Serial sectioning and immunohistochemistry resulted in a mean upstaging of 18.9 % (range 0-50 %). True upstaging defined as micrometastases (pN1mi+) rather than isolated tumor cells (pN0itc+) was 7.7 %. The SN procedure in colorectal cancer has an overall sensitivity of 70 %, with increased sensitivity and refined staging in early-stage colon cancer. Because the ex vivo SN mapping is an easy technique it should be considered in addition to conventional resection in colon cancer

U2 - 10.1245/s10434-012-2417-0

DO - 10.1245/s10434-012-2417-0

M3 - Article

C2 - 22644513

VL - 19

SP - 3449

EP - 3459

JO - Annals of surgical oncology

JF - Annals of surgical oncology

SN - 1068-9265

IS - 11

ER -