Ultrastaging of sentinel lymph nodes (SLNs) vs. non-SLNs in colorectal cancer--do we need both?

Research paper by David D Wiese, Saad S Sirop, Brian B Yestrepsky, Maher M Ghanem, Nader N Bassily, Peter P Ng, Weimin W Liu, Ernesto E Quiachon, Aamir A Ahsan, Julio J Badin, Sukamal S Saha

Indexed on: 17 Mar '10Published on: 17 Mar '10Published in: The American Journal of Surgery®


The aim of this study to analyze whether ultrastaging of initially negative nonsentinel lymph nodes (non-SLNs) would increase nodal positivity in colon cancer and rectal cancer.After SLN mapping (SLNM), SLNs were ultrastaged by 4 hematoxylin and eosin and 1 immunohistochemistry sections. A blinded pathologist reexamined initially negative non-SLNs by 3 additional hematoxylin and eosin and 1 immunohistochemistry sections.In 156 colon cancer and 44 rectal cancer patients, 2,755 nodes were identified (494 SLNs and 2,261 non-SLNs). Metastases were detected in 20.9% of SLNs and 8.6% of non-SLNs (P<.0001). After ultrastaging non-SLNs, only .58% became positive for metastases in 12 patients. Of these, 10 already had positive lymph nodes, hence no change of staging occurred. Ultrastaging upstaged only 2 of 200 patients (1%).The chance of finding additional metastases by ultrastaging of all non-SLNs is extremely low (<1%) and of little benefit.