Annals of Surgical Oncology

, 16:2166 | Cite as

A Prospective Study of False-Positive Diagnosis of Micrometastatic Cells in the Sentinel Lymph Nodes in Colorectal Cancer

  • D. Wiese
  • S. Saha
  • B. Yestrepsky
  • A. Korant
  • S. Sirop
Gastrointestinal Oncology

Abstract

Introduction

Sentinel lymph node mapping (SLNM) with multilevel sections (MLS) and cytokeratin immunohistochemistry (CK-IHC) of sentinel lymph nodes (SLNs) upstages 15–20% of patients (pts). False-positive SLNs occur in breast cancer due to mechanical transport of cells during mapping procedures, or to pre-existing benign cellular inclusions. Our prospective study evaluated whether colorectal mapping procedures alone caused false positives.

Methods

A total of 314 pts underwent SLNM with blue dye. Ninety of the pts underwent a second mapping in normal bowel away from the primary tumor. The first 1–5 blue nodes near the primary tumor were marked as SLNs; those near the second injection site were marked as nontumor SLNs (nt-SLNs). All SLNs and nt-SLNs were evaluated by MLS and CK-IHC.

Results

Of 314 pts, 30 had benign tumor and 284 had invasive cancer. SLNM was successful in 274/284 (96.5%) invasive cancer pts, with 728 SLNs identified. Forty-six of the 274 pts (16.8%) had low-volume metastasis in 57 SLNs: 31 pts (11.3%) had 38 SLNs with micrometastasis (>0.2 mm, ≤2 mm), while 15 pts (5.5%) had 19 SLNs with isolated tumor cells (≤0.2 mm). For 100 pts with second SLNM (70/90 pts successfully mapped with 102 nt-SLNs), or with SLNM of benign pathology (30/30 pts successfully mapped with 88 SLNs), there were no false positives in any of 190 nodes (P < 0.001).

Conclusion

No false positives due to mechanical transport of cells or to benign cellular inclusions were identified in 190 lymph nodes from 100 patients with SLNM in benign bowel.

Keywords

Sentinel Lymph Node Methylene Blue Mesothelial Cell Mapping Procedure Isolate Tumor Cell 

Notes

Acknowledgment

The authors thank Drs. Julio Badin, Peter Ng, Nader Bassily, Weimin Liu, Ernesto Quiachon, and Aamir Ahsan for their participation in the pathologic evaluation of the cases.

DISCLOSURES

No commercial or other disclosures are reported by the authors of this study.

References

  1. 1.
    Saha S, Dan A, Viehl C, Zuber M, Wiese D. Sentinel lymph node mapping in colon and rectal cancer: its impact on staging, limitations, and pitfalls. Cancer Treat Res. 2005;127:105–22.PubMedCrossRefGoogle Scholar
  2. 2.
    Greene F, Page D, Fleming I, Fritz A, Balch C, Haller D, Morrow M. AJCC cancer staging manual, 6th ed. New York: Springer-Verlag; 2002.Google Scholar
  3. 3.
    Carter B, Jensen R, Simpson J, Page D. Benign transport of breast epithelium into axillary lymph nodes after biopsy. Am J Clin Pathol. 2000;113:259–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Diaz N, Cox C, Ebert M, Clark J, Vrcel V, Stowell N, et al. Benign mechanical transport of breast epithelial cells to sentinel lymph nodes. Am J Surg Pathol. 2005;28:1641–5.Google Scholar
  5. 5.
    Diaz N, Vrcel V, Centeno B, Muro-Cacho C. Modes of benign mechanical transport of breast epithelial cells to axillary lymph nodes. Adv Anat Pathol. 2005;12:7–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Diaz N, Mayes J, Vrcel V. Breast epithelial cells in dermal angiolymphatic spaces: a manifestation of benign mechanical transport. Hum Pathol. 2005;36:310–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Tamhane R, Dahlstrom J, McCallum D, Buckingham M. The clinical significance of cytokeratin-positive cells in lymph nodes at the time of mastectomy from patients with ductal carcinoma-in-situ. Ann Surg Oncol. 2002;9:999–1003.PubMedCrossRefGoogle Scholar
  8. 8.
    King T, Ganaraj A, Fey J, et al. Cytokeratin-positive cells in sentinel lymph nodes in breast cancer are not random events: experience in patients undergoing prophylactic mastectomy. Cancer. 2004;101:926–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Saha S, Dan A, Viehl C, Zuber M, Wiese D. Sentinel lymph node mapping in colon and rectal cancer: its impact on staging, limitations and pitfalls. In: Leong S, Kitagawa Y, Kitajima M, editors. Selective sentinel lymphadenectomy for human solid cancer. New York: Springer-Verlag; 2005. p. 105-22.CrossRefGoogle Scholar
  10. 10.
    Rao R, Taylor J, Palmer J, Jennings W. Breast cancer pseudometastasis in a sentinel lymph node with cytokeratin-positive debris. Breast J. 2005;11:134–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Rosenberg R, Hoos A, Mueller J, et al. Prognostic significance of cytokeratin-20 reverse transcriptase polymerase chain reaction in lymph nodes of node-negative colorectal cancer patients. J Clin Oncol. 2002;20:1049–1055.PubMedCrossRefGoogle Scholar
  12. 12.
    Davies M, Arumugam PJ, Shah VI, Watkins A, Roger Morgan A, Carr ND, et al. The clinical significance of lymph node micrometastasis in stage I and stage II colorectal cancer. Clin Transl Oncol. 2008;10:175–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Bianchi M, Tono L. Contribution to the study of epithelial inclusions of the lymph nodes. Anatomo-clinical considerations on a case of glandular inclusions of the axillary lymph nodes. Arch De Vecchi Anat Patol. 1950, 30:307–19.Google Scholar
  14. 14.
    Fragetta F, Vasquez E. Epithelial inclusion in axillary lymph node associated with a breast carcinoma: report of a case with a review of the literature. Pathol Res Pract. 1999;195:263–6.Google Scholar
  15. 15.
    Schneider, V. Benign glandular lymph node inclusions. Diagn Gynecol Obstet. 1980;2:313–20.PubMedGoogle Scholar
  16. 16.
    Brooks J, LiVolsi V, Pietra G. Mesothelial inclusions in mediastinal lymph nodes mimicking metastatic carcinoma. Am J Clin Pathol. 1990;93:741–8.PubMedGoogle Scholar
  17. 17.
    Yakoushina T, Morotti R, Strauchen J, Unger P. Renal benign epithelial nodal inclusions. Ann Diagn Pathol. 2008;12:181–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Marques B, Gay G, Jozan S, Mirouze A, David J. Embryologic origin of salivary inclusions in the parotid lymph nodes. Bull Assoc Anat (Nancy). 1983;67:219–28.Google Scholar
  19. 19.
    Peng Y, Ashfaq R, Ewing G, Leitch A, Mohlberg K. False-positive sentinel lymph nodes in breast cancer patients caused by benign glandular inclusions: report of three cases and review of the literature. Am J Clin Pathol. 2008;130:21–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Turner R, Nora D, Trocha S, Bilchik A. Colorectal carcinoma staging. Frequency and nature of cytokeratin positive cells in sentinel and non-sentinel lymph nodes. Arch Pathol Lab Med. 2003;127:673–9.PubMedGoogle Scholar
  21. 21.
    Redston M, Compton C, Miedema B, Niedzwiecki B, et al. Analysis of micrometastatic disease in sentinel lymph nodes from resectable colon cancer: results of Cancer and Leukemia Group B Trial 80001. J Clin Oncol. 2006;24:878–83.PubMedCrossRefGoogle Scholar
  22. 22.
    Wong JH, Johnson DS, Namiki T, Tauchi-Nishi P. Validation of ex vivo lymphatic mapping in hematoxylin-eosin node-negative carcinoma of the colon and rectum. Ann Surg Oncol. 2004;11:772–7.PubMedCrossRefGoogle Scholar
  23. 23.
    van Schaik PM, van der Linden JC, Ernst MF, Gelderman WA, Bosscha K. Ex vivo sentinel lymph node “mapping” in colorectal cancer. Eur J Surg Oncol. 2007;33:1177–82.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • D. Wiese
    • 1
  • S. Saha
    • 2
  • B. Yestrepsky
    • 1
  • A. Korant
    • 2
  • S. Sirop
    • 2
  1. 1.Department of PathologyMichigan State University, McLaren Regional Medical CenterFlintUSA
  2. 2.Department of SurgeryMichigan State University, McLaren Regional Medical CenterFlintUSA

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