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Note publique d'information : surgery. Detailed histopathological examination (- value of 95%, where in only one
case was metastasis cluding multilevel sectioning, immunohistochemistry found in a
non-SLN [94]. staining, monoclonal antibody staining, and reverse All the efforts
in SLN identification so far discussed transcriptasepolymerase chain reaction assay)
can re- werebasedoninjectionofadyeintothesubserosall- vealmicrometastasesandleadstoultrastaging,butap-
er(intraoperatively)orinthesubmucosallayer(pre- plication of the technique to all
lymph nodes in a re- eratively usinga colonoscope orproctoscope). The use sectedspecimenisnotpracticallyfeasible.Thesentinel
ofaradiotracertodelineatethelymphaticchannelswas lymph node concept is therefore a
method capable of highlighted in a very small number of publications. A pointingoutthefirstnodetoreceivedrainagefromthe
group of 56 colorectal cancer patients had sentinel tumorandtorepresentthefirsttoharbormicrometas-
lymph node mapping intraoperatively using gamma tasisifany.Theutilizationoftheconceptinthecontext
probeguidanceastheonlymethodforSLNidentifi- ofcolorectalcancerisdifferentthanthatinbreastcan-
tion.SLNsweredetectedin91%ofpatients.Metastasis cerasanexample.Inthelatter,SLNidentification
wasseenin22%ofSLNsasopposedto3%ofnon-SLNs. aims to avoid unnecessary surgical exploration
and InfourcasesSLNswerefalselynegativelyinthepr- resection of axillary nodes in the
basin if the SLN is enceofmetastasisinothernon-SLNs,andanadvanced negative for tumor.
In colorectal cancer, however, the case of colorectal cancer was a common finding
(a T3 regional lymph nodes are already removed en block primary tumor) [95]. Whether
tumor burden causes andthereisnochangeinsurgicalextentoutofthein- blockingordiversionoflymphaticchannelsremainsto
formation derived from SLN status. Alternatively, the be investigated. aim is to identify
(either intraoperatively or during Trochaetal.[96]studied48colorectalpatientsusing
pathologicalexamination)asmallergroupofnodesin a combination of radiotracer and blue
dye. thespecimenandtofocusallhistopathologicalefforts Inallidentifiednodesthereweresignificantlyfewer
on such nodes in order to dramatically increase the nodes positive by both methods
“blue and hot” than yield.Inaddition,anappealingfeatureisthatcolorec- “blueonly”.Inaddition,nodalmetastasiswasmore
tal cancer exhibits a very predictable pattern for lym- commoninthoseblueandhotthanblueonlynodes.
phaticdrainagechannels.Despitealloftheseobserva- This signifies that dual-agent examination
more ac- tions and expectations, the application of the sentinel ratelyidentifiesSLNandaccordinglyfurtherdecreases
lymphnodeconceptincolorectalcancer(asinallgas- thenumberofnodestobeexaminedbythepathologist
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