This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bilchik, A. J. Articles by Morton, D. L. Search for Related Content PubMed PubMed Citation Articles by Bilchik, A. J. Articles by Morton, D. L. Social Bookmarking                            What's this?

Effect of Lymphatic Mapping on the New Tumor-Node-Metastasis Classification for Colorectal Cancer

Anton J. Bilchik, Dean T. Nora, Leslie H. Sobin, Roderick R. Turner, Steven Trocha, David Krasne, Donald L. Morton

From the Division of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA; and the Division of Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DC.

Address reprint requests to Anton J. Bilchik, MD, PhD, John Wayne Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA 90404; email: bilchika{at}jwci.org.

Purpose: Sensitive detection methods and accurate reporting are necessary to determine the prognostic significance of micrometastases (MM) and isolated tumor cells (ITCs) in lymph nodes that drain colorectal cancers (CRCs). This study examined the role of lymphatic mapping (LM) in the application of the new tumor-node-metastasis (TNM) classification for MM and ITC.

Patients and Methods: All patients at the John Wayne Cancer Institute underwent LM immediately before standard resection of primary CRC between 1996 and 2001. Sentinel nodes (SNs) were identified using blue dye and/or radiotracer and were examined by hematoxylin-eosin (H&E) staining, cytokeratin immunohistochemistry, and multilevel sectioning. The comparison group comprised 370 patients whose primary CRCs were resected without LM during the same period at the same institution.

Results: LM was successfully performed in 115 of 120 (96%) patients and correctly predicted the tumor status of the nodal basin in 110 of 115 (96%) patients. Thirty-seven patients (32%) were lymph node-positive by H&E; ITC and MM were found in 23 patients (29.4%) whose lymph nodes were negative by H&E. Tumor deposits were found in the SN only in 29 patients (50%). Nodal involvement was identified for 14.3%, 30%, 74.6%, and 83.3% of T1, T2, T3, and T4 tumors, respectively, in the study group, and for 6.8%, 8.5%, 49.3%, and 41.8% of T1, T2, T3, and T4 tumors, respectively, in the comparison group. The study group had a higher percentage of nodal metastases (53% v 36%; P < .01) and a higher incidence of MM and ITC (29.4% v 1.9%; P < .0001). The mean number of lymph nodes found in the study group (14) was also significantly more than the number found in the comparison group (10; P < .00001).

Conclusion: Conventional examination of lymph nodes for CRC is inadequate for the detection of MM and ITC as described in the new TNM classification. Thus, LM and focused SN analysis should be considered to fully stage CRC.

Supported by grant CA090848 from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and by funding from the Rogovin-Davidow Foundation, Los Angeles, CA, the Rod Fasone Memorial Cancer Fund, Indianapolis, IN, and the U.S. Surgical Corp, Norwalk, CT.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				K. Koyanagi, A. J. Bilchik, S. Saha, R. R. Turner, D. Wiese, M. McCarter, P. Shen, L. Deacon, D. Elashoff, and D. S.B. Hoon Prognostic Relevance of Occult Nodal Micrometastases and Circulating Tumor Cells in Colorectal Cancer in a Prospective Multicenter Trial Clin. Cancer Res., November 15, 2008; 14(22): 7391 - 7396. [Abstract] [Full Text] [PDF]

				M. F.G. de Maat, C. J.H. van de Velde, M. P.J. van der Werff, H. Putter, N. Umetani, E. M. Klein-Kranenbarg, R. R. Turner, J. H. J.M. van Krieken, A. Bilchik, R. A.E.M. Tollenaar, et al. Quantitative Analysis of Methylation of Genomic Loci in Early-Stage Rectal Cancer Predicts Distant Recurrence J. Clin. Oncol., May 10, 2008; 26(14): 2327 - 2335. [Abstract] [Full Text] [PDF]

				D. M. Iddings, E. A. Koda, S. S. Grewal, R. Parker, S. Saha, and A. Bilchik Association of Angiogenesis Markers With Lymph Node Metastasis in Early Colorectal Cancer Arch Surg, August 1, 2007; 142(8): 738 - 745. [Abstract] [Full Text] [PDF]

				A. J. Bilchik, M. DiNome, S. Saha, R. R. Turner, D. Wiese, M. McCarter, D. S. B. Hoon, and D. L. Morton Prospective Multicenter Trial of Staging Adequacy in Colon Cancer: Preliminary Results Arch Surg, June 1, 2006; 141(6): 527 - 534. [Abstract] [Full Text] [PDF]

				M. B. Faries, R. J. Bleicher, X. Ye, R. Essner, and D. L. Morton Lymphatic Mapping and Sentinel Lymphadenectomy for Primary and Metastatic Pulmonary Malignant Neoplasms Arch Surg, August 1, 2004; 139(8): 870 - 877. [Abstract] [Full Text] [PDF]

				F. L. Greene, A. K. Stewart, and H. J. Norton New Tumor-Node-Metastasis Staging Strategy for Node-Positive (stage III) Rectal Cancer: An Analysis J. Clin. Oncol., May 15, 2004; 22(10): 1778 - 1784. [Abstract] [Full Text] [PDF]