P-0235 - Individualization of surgical treatment for digestive carcinoma based on sentinel lymph node biopsy

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Gastrointestinal Cancers
Surgery and/or Radiotherapy of Cancer
Presenter Nebojsa Mitrovic
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors N. Mitrovic, D. Jasarovic, D. Stevanovic, D. Stojanovic
  • University Hospital Zemun, Belgrade/RS

Abstract

Introduction

The prediction of outcome for patients with digestive cancer is determined largely by the presence of lymph node metastases, which could be detected by sentinel lymph node (SLN) biopsy (SLNB). The purpose of this work was to determine the feasibility of SLNB in patients with colon and gastric cancer for the assessment of regional lymph node status, including performing immunohistochemical (IHC) staining of SLN tissue. Our goal is to contribute to surgical treatment individualization and early discovering of micro-metastases for digestive system carcinoma using a sentinel node biopsy.

Methods

The prospective clinical trail included 156 operated patients, 90 with colon carcinoma, and 66 with gastric carcinoma admitted to Surgery Clinic “Zemun” in Belgrade. Sentinel lymph-node mapping is being performed by subserosis injection 1% of Lymphazurin (colon “ex vivo”, and gaster“in vivo”). Ultra-staging by immunohistochemical analysis was performed in those SLN which did not have metastases (that is, standard histological check was negative). Than, these criteria were analyzed and correlated with lymphonodal status and clinicopathological factors.

Results

Sentinel lymph nodes (SLN) were successfully identified in 154 (96,64%) cases of colon carcinoma and 100% in cases of gastric carcinoma. Total number of identified SLN accounted for 428, of which 232 (4,14 per patient) for colon, and 196 (3, 54 per patient) for gastric carcinoma. Aberrant lymph drainage is more frequent in colon carcinoma (23,8%) than in gastric carcinoma (14,3%). In 46 cases with negative colon SLN, with no macro-metastases, immunohistochemical (IHC) analysis was done, which helps us to determine the presence of micro-metastases in 26,9%. When it comes to gastric carcinoma 62, 5% (128,4) SLN was metastatically changed, and metastases were found in non-SLN only in cases when SLN were positive, which means that “skip” metastases were not identified in neither cases. In 37,5% gastric carcinoma there were no metastases at standard histopathological check, but IHC analysis determined the presence of micro-metastases in 38,09% or 8 patients. Multivariate analysis shows the SLN metastases frequency of pT3/ pT2; Odds ratio 4,836(0 < 0,01). The sensitivity of the SLN biopsy in diagnosis of the lymph node status was 100%.

Conclusion

Sentinel nodes biopsy using 1% lymphazurin in colon and gastric cancer is a feasible method with very high sensitivity and uniqueness (100%). Intraoperative diagnosis of SLN micrometastasis is a crucial for planning the operation and adjuvant therapy because SLN biopsy helps with more rigorous pathological analysis and up staging from I or II to III stadium of digestive carcinoma. Based on this principle, we can individualize therapy and minimally invasive surgical techniques must be preceded by SLN biopsy.