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In vivo and ex vivo sentinel node mapping does not identify the same lymph nodes in colon cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Identification of lymph nodes and pathological analysis is crucial for the correct staging of colon cancer. Lymph nodes that drain directly from the tumor area are called “sentinel nodes” and are believed to be the first place for metastasis. The purpose of this study was to perform sentinel node mapping in vivo with indocyanine green and ex vivo with methylene blue in order to evaluate if the sentinel lymph nodes can be identified by both techniques.

Methods

Patients with colon cancer UICC stage I–III were included from two institutions in Denmark from February 2015 to January 2016. In vivo sentinel node mapping with indocyanine green during laparoscopy and ex vivo sentinel node mapping with methylene blue were performed in all patients.

Results

Twenty-nine patients were included. The in vivo sentinel node mapping was successful in 19 cases, and ex vivo sentinel node mapping was successful in 13 cases. In seven cases, no sentinel nodes were identified. A total of 51 sentinel nodes were identified, only one of these where identified by both techniques (2.0%). In vivo sentinel node mapping identified 32 sentinel nodes, while 20 sentinel nodes were identified by ex vivo sentinel node mapping. Lymph node metastases were found in 10 patients, and only two had metastases in a sentinel node.

Conclusion

Placing a deposit in relation to the tumor by indocyanine green in vivo or of methylene blue ex vivo could only identify sentinel lymph nodes in a small group of patients.

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Acknowledgements

The project was financed by internal resources and by a grant from the Beckett-Foundation. Equipment was provided by Karl Storz (Karl Storz GmbH and Co. KG, Tüttlingen, Germany) for the surgeries performed in Zealand University Hospital. We are grateful to Henrik Loft Jakobsen, MD, who led the surgical contribution to the study from Herlev Hospital.

Authors’ contribution

Helene S Andersen, Astrid L B Bennedsen, Stefan K Burgdorf, Jens R Eriksen, Anders Toxværd, Lene B Riis, Jacob Rosenberg, and Ismail Gögenur contributed for the study conception and design; Helene S Andersen, Astrid L B Bennedsen, Jens R Eriksen, Susanne Eiholm, Anders Toxværd, Lene B Riis, and Ismail Gögenur for the acquisition of data; Helene S Andersen, Astrid L B Bennedsen, and Ismail Gögenur for the analysis and interpretation of data; Helene S Andersen, Astrid L B Bennedsen, and Ismail Gögenur for the drafting of the manuscript; and Helene S Andersen, Astrid L B Bennedsen, Stefan K Burgdorf, Jens R Eriksen, Susanne Eiholm, Anders Toxværd, Lene B Riis, Jacob Rosenberg, and Ismail Gögenur for the critical revision of the manuscript.

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Authors and Affiliations

  1. Zealand University Hospital, Copenhagen University, Lykkebækvej 1, 4600, Køge, Denmark

    Helene Schou Andersen, Astrid Louise Bjørn Bennedsen, Jens Ravn Eriksen, Susanne Eiholm & Ismail Gögenur

  2. Rigshospitalet, Blegdamsvej 9, 2100, København Ø, Denmark

    Stefan Kobbelgaard Burgdorf

  3. Herlev Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark

    Anders Toxværd, Lene Buhl Riis & Jacob Rosenberg

Authors
  1. Helene Schou Andersen
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  2. Astrid Louise Bjørn Bennedsen
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  3. Stefan Kobbelgaard Burgdorf
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  4. Jens Ravn Eriksen
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  6. Anders Toxværd
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  7. Lene Buhl Riis
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  8. Jacob Rosenberg
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  9. Ismail Gögenur
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Corresponding author

Correspondence to Helene Schou Andersen.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the regional research ethics committee and the Danish Data Protection Agency. The study was registered at www.clinicaltrials.gov (NCT02167087) before inclusion of the first patient.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Helene Schou Andersen and Astrid Louise Bjørn Bennedsen shared the first authorship.

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Andersen, H.S., Bennedsen, A.L.B., Burgdorf, S.K. et al. In vivo and ex vivo sentinel node mapping does not identify the same lymph nodes in colon cancer. Int J Colorectal Dis 32, 983–990 (2017). https://doi.org/10.1007/s00384-017-2777-9

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  • DOI: https://doi.org/10.1007/s00384-017-2777-9

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