Near-infrared (NIR) fluorescence imaging for SLNM has several properties that are advantageous for the SLN procedure in colon cancer and has already shown promising results in several types of cancer. The limited penetration depth and fast migration of current blue dyes, resulting in high false-negative rates, are frequently mentioned as serious drawbacks of SLNM. The concept of sentinel lymph node mapping (SLNM) in colon cancer as a staging technique has been described frequently, with variable results. On the other hand, the majority of colon cancer patients without lymph node metastasis are exposed to unnecessary surgery-related morbidity and mortality, currently of 13.5% and 2.0%, respectively. However, these techniques are time consuming and expensive and are, therefore, not appropriate for daily practice. Detailed examination of all lymph nodes using serial sectioning and immunohistochemistry (IHC) is desirable. This high recurrence rate in node-negative colon tumors could be the result of understaging due to missed occult tumor cells (e.g., isolated tumor cells or micrometastases) during routine histopathological examination or inadequate lymph node harvesting. Despite complete segmental resection, up to 20–30% patients with early-stage disease will develop distant metastasis and eventually die from colon cancer. However, current treatment by segmental resection with en bloc resection of lymph nodes is unavoidable as long as uncertainties about undetected lymph node metastasis remain. The low risk of lymph node metastasis in these early-stage tumors makes local excision of the primary tumor an attractive treatment option. Lymph node metastases are the strongest predictive factor for patient survival. Future studies should try to standardize the SLNM procedure and focus on early-stage colon tumors, validation of tracer composition, injection mode and improvement of real-time optical guidance.Ĭolon cancer is one of the most common malignancies in the Western world and the number of early-stage tumors (T1 and T2) identified is expected to increase as a result of the introduction of nationwide screening programs. As a consequence, reports of SLNM accuracy vary widely. Several anatomical and technical difficulties make SLNM with NIR fluorescence imaging in colon cancer particularly challenging when compared to other types of cancer. Eight patients had lymph node metastases, in three cases detected after extended pathological assessment, resulting in an upstaging of 13% (3 of 23 patients with negative nodes by conventional hematoxylin and eosin staining). Five false-negative SLNs were identified, resulting in a sensitivity of 44% and negative predictive value of 80%, with a detection rate of 89.7%. In our single-center study, we included 30 patients. Upstaging as a result of extended histopathological assessment was 0.15 (95% CI 0.07–0.25). This systematic review and meta-analysis included 8 studies describing 227 SLN procedures. Sensitivity, negative predictive value and detection rate were calculated. SLN procedures yielding tumor-negative SLNs in combination with tumor-positive regional lymph nodes were classified as false negatives. SLN procedures were determined to be true negatives if SLNs and regional lymph nodes revealed no metastases after conventional and advanced histopathology. A true-positive procedure was defined as a tumor-positive SLN either by conventional hematoxylin-and-eosin staining or by extended histopathological assessment, independently of regional lymph node status. ![]() SLNs were analyzed with conventional hematoxylin-and-eosin staining and additionally with serial sectioning and immunohistochemistry (extended histopathological assessment). Additionally, we performed a single-center study using indocyanine green (ICG) as SLNM dye in colon cancer patients scheduled for a laparoscopic colectomy. MethodsĪ systematic review and meta-analysis was conducted to identify currently used methods and results. Our aim was to provide an overview of current SLNM performance and of factors influencing successful sentinel lymph node (SLN) identification using NIR fluorescence imaging in colon cancer. ![]() ![]() Near-infrared (NIR) fluorescence imaging has the potential to overcome the current drawbacks of sentinel lymph node mapping (SLNM) in colon cancer.
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