cx r22 2 45 218870086 http://www.idref.fr/218870086 20171022 20260701144701.000 0499 0499 Tr2 20171022afrey50 ba0 eng 639-2 2001 u fre 0 # # AFNOR Oeuvre Textuelle ba0yba0 The Pathophysiologic Basis of Nuclear Medicine ba0yba0y 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 069216797 ba0yba02 Elgazzar Abdelhamid H. 1949- 070 027578666 Médecine nucléaire rameau 027352668 Scintigraphie rameau Imaging / Radiology lc Medicine & Public Health lc Medicine lc Radiology, Medical lc Cardiology lc Oncology lc Pathology lc Cardiology lc Oncology lc Pathology lc Radiology lc Nuclear Medicine lc Nuclear medicine lc Radioisotope scanning lc Nuclear Medicine mesh Radionuclide Imaging mesh Medicine & Public Health Nuclear Medicine Imaging / Radiology Oncology Pathology Cardiology FR Abes 20260701 AFNOR