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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 \u201cblue and hot\u201d than yield.Inaddition,anappealingfeatureisthatcolorec- \u201cblueonly\u201d.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"}],"tag":300},{"ind2":1,"ind1":" ","subfield":[{"code":3,"content":"069216797"},{"code":7,"content":"ba0yba02"},{"code":"a","content":"Elgazzar"},{"code":"b","content":"Abdelhamid H."},{"code":"f","content":"1949-"},{"code":4,"content":"070"}],"tag":501},{"ind2":" ","ind1":" ","subfield":[{"code":3,"content":"027578666"},{"code":"a","content":"Médecine nucléaire"},{"code":2,"content":"rameau"}],"tag":606},{"ind2":" ","ind1":" ","subfield":[{"code":3,"content":"027352668"},{"code":"a","content":"Scintigraphie"},{"code":2,"content":"rameau"}],"tag":606},{"ind2":" ","ind1":2,"subfield":[{"code":"a","content":"Imaging / Radiology"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":1,"subfield":[{"code":"a","content":"Medicine & Public Health"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":" ","subfield":[{"code":"a","content":"Medicine"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":" ","subfield":[{"code":"a","content":"Radiology, Medical"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":2,"subfield":[{"code":"a","content":"Cardiology"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":2,"subfield":[{"code":"a","content":"Oncology"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":2,"subfield":[{"code":"a","content":"Pathology"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":" ","subfield":[{"code":"a","content":"Cardiology"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":" ","subfield":[{"code":"a","content":"Oncology"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":" ","subfield":[{"code":"a","content":"Pathology"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":" ","subfield":[{"code":"a","content":"Radiology"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":2,"subfield":[{"code":"a","content":"Nuclear Medicine"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":" ","subfield":[{"code":"a","content":"Nuclear medicine"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":" ","subfield":[{"code":"a","content":"Radioisotope scanning"},{"code":2,"content":"lc"}],"tag":606},{"ind2":" ","ind1":1,"subfield":[{"code":"a","content":"Nuclear Medicine"},{"code":2,"content":"mesh"}],"tag":606},{"ind2":" ","ind1":2,"subfield":[{"code":"a","content":"Radionuclide Imaging"},{"code":2,"content":"mesh"}],"tag":606},{"ind2":" ","ind1":1,"subfield":{"code":"a","content":"Medicine & Public Health"},"tag":610},{"ind2":" ","ind1":2,"subfield":{"code":"a","content":"Nuclear Medicine"},"tag":610},{"ind2":" ","ind1":2,"subfield":{"code":"a","content":"Imaging / Radiology"},"tag":610},{"ind2":" ","ind1":2,"subfield":{"code":"a","content":"Oncology"},"tag":610},{"ind2":" ","ind1":2,"subfield":{"code":"a","content":"Pathology"},"tag":610},{"ind2":" ","ind1":2,"subfield":{"code":"a","content":"Cardiology"},"tag":610},{"ind2":3,"ind1":" ","subfield":[{"code":"a","content":"FR"},{"code":"b","content":"Abes"},{"code":"c","content":20260701},{"code":"g","content":"AFNOR"}],"tag":801}],"controlfield":[{"tag":"001","content":218870086},{"tag":"003","content":"http://www.idref.fr/218870086"},{"tag":"004","content":20171022},{"tag":"005","content":20260701144701},{"tag":"006","content":"0499"},{"tag":"007","content":"0499"},{"tag":"008","content":"Tr2"}]}}