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Metastasis of Colorectal Cancer pp 343–358Cite as

The Sentinel Lymph Node and Staging of Colorectal Cancer

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Part of the book series: Cancer Metastasis - Biology and Treatment ((CMBT,volume 14))

Abstract

The use of sentinel lymph node (SLN) biopsy (SLNB) for staging of colorectal cancer (CRC) is a controversial issue. To clarify the usefulness of this technique with its different modalities of detection and various protocols for the histopathological work-up of the SLN, we performed a meta-analysis (MA) about the feasibility of this approach. We compared this new method of lymph node staging in colorectal cancer to standard evaluation of lymph node involvement. In our MA, the global sensitivity of sentinel lymph node mapping (SLNM) was 70% with an 81% level of specificity. The pooled DAOR (Diagnostic Accuracy Odds Ratio) was 10.7 (95% CI: 7–16.5). This means that a patient whose SLN is invaded has 10.7 times more risk to be node-positive than an SLN-negative patient. SLN mapping in CRC seems feasible but a learning curve is necessary. Saha et al. has gained a considerable experience with this technique, attested by their numerous publications. In their hands, SLN mapping had a better sensitivity (90%) than in other studies. The SLNM technique should be better standardized in future studies. On the other hand, we know that SLNB is successfully applied in breast cancer since it offers esthetical advantage by avoiding large biopsy. In this regard, CRC differs from breast cancer. Nevertheless, a major benefit may be obtained in CRC since SLNB permits upstaging of some cancer and better evaluation of lymph node involvement, thanks to thin slicing of SLN. Although this issue is still under debate, there is growing evidence that, if at least RT-PCR-techniques were used, the detection of small tumour deposits in the SLN might be of prognostic and thus of clinical value. Future studies should focus on two aspects. First, careful patient selection may allow determining whether an improvement of the sensitivity to detect macrometastases is feasible. Second, large prospective trials using a standardized histopathological lymph node assessment should compare SLN and Non-SLN for their incidence to bear small tumour deposits. If SLNB proves to be a sensitive technique, its prognostic and predictive value should be evaluated.

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Abbreviations

CRC:

Colorectal cancer

DAOR:

Diagnostic Accuracy Odds Ratio

FN:

False negative

FP:

False positive

FOLFOX:

5-FU/leucovorin/oxaliplatin

HE:

Hematoxylin/eosin

IHC:

Immunohistochemistry

LN:

Lymph node

MA:

Meta-analysis

SLN:

Sentinel lymph node

SLNB:

Sentinel lymph node biopsy

SLNM:

Sentinel lymph node mapping

SN:

Sentinel node

TN:

True negative

TP:

True positive

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Authors and Affiliations

  1. Department of Oncology, APHP, hôpital Avicenne, Bobigny, 93009, France

    Gaetan des Guetz

  2. Department of Pharmacology, APHP, hôpital Avicenne, Bobigny, 93009, France

    Bernard Uzzan

Authors
  1. Gaetan des Guetz
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  2. Bernard Uzzan
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Correspondence to Gaetan des Guetz .

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Editors and Affiliations

  1. Rosalind & Morris Goodman Cancer, Research Centre, McGill University, Promenade Sir William Osler 3655, Montreal, H3G 1Y6, Canada

    Nicole Beauchemin

  2. Hôpital L’Hôtel-Dieu de Québec, Centre de Recherche en Cancérologie, Université Laval, rue McMahon 9, Quebec, G1R 2J6, Canada

    Jacques Huot

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des Guetz, G., Uzzan, B. (2010). The Sentinel Lymph Node and Staging of Colorectal Cancer. In: Beauchemin, N., Huot, J. (eds) Metastasis of Colorectal Cancer. Cancer Metastasis - Biology and Treatment, vol 14. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-8833-8_12

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