Intraoperative sentinel lymph node mapping in patients with colon cancer: Study of 38 cases

Background/aims: Sentinel lymph node mapping has become a cornerstone of oncologic surgery because it is a proven method for identifying nodal disease in melanoma and breast cancer. In addition, it can ameliorate the surgical morbidity secondary to lymphadenectomy. However, experience with sentinel lymph node mapping for carcinoma of the colon and other visceral malignancies is limited. The purpose of this study was to evaluate the feasibility and reliability of in vivo sentinel lymph node mapping in patients with colon cancer. Methods: In the period March 2004 through June 2009, 38 patients underwent curative surgery for colon cancer. Thirty-eight patients with intraperitoneal colon tumors undergoing resection were studied prospectively. Sentinel lymph nodes were identified as the first blue-stained node(s) after in vivo peritumoral injection of Isosulfan blue dye. Results: Detection of sentinel lymph nodes was successful in 36 out of 38 colon cancer patients. In 94.7% of the patients with colon cancer, at least one sentinel lymph node was found. No patients had a false negative sentinel node. The sensitivity was 100%, with a negative predictive value of 100%. Aberrant lymphatic drainage was not identified in any patient. Conclusion: The technique of in vivo sentinel lymph node mapping is technically feasible with high sensitivity, high negative predictive value, and high accuracy. Although sentinel lymph node mapping did not alter the surgical management of colon cancer, it does make possible a more focused and cost-er fective pathologic evaluation of nodal disease.