Ann Coloproctol.  2019 Aug;35(4):174-180. 10.3393/ac.2018.07.21.1.

Sentinel Lymph Node Analysis in Colorectal Cancer Patients Using One-Step Nucleic Acid Amplification in Combination With Fluorescence and Indocyanine Green

Affiliations
  • 1Oncological and General Surgery Unit, St. Giuseppe Moscati Hospital of National Relevance and High Specialty, Avellino, Italy. crafa@tiscali.it
  • 2General and Emergency Surgery Unit, Civico Benfratelli Di Cristina Hospital, Palermo, Italy.
  • 3Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
  • 4Institute of Pathology, St. Giuseppe Moscati Hospital of National Relevance and High Specialty, Avellino, Italy.

Abstract

PURPOSE
Analysis of the sentinel lymph node (SLN) in colorectal cancer (CRC) patients was proposed for more accurate staging and tailored lymphadenectomy. The aim of this study was to assess the ability to predict lymph node (LN) involvement through analysis of the SLN with a one-step nucleic acid (OSNA) technique in combination with peritumoral injection of indocyanine green (ICG) and near-infrared (NIR) lymphangiography in CRC patients.
METHODS
A total of 34 patients were enrolled. Overall, 51 LNs were analyzed with OSNA. LNs of 17 patients (50%) were examined simultaneously with hematoxylin and eosin (H&E) and OSNA.
RESULTS
SLN analysis of 17 patients examined with H&E and OSNA revealed that OSNA had a higher sensitivity (1 vs. 0.55), higher negative predictive value (1 vs. 0.66) and higher accuracy (100% vs. 76.4%) in predicting LN involvement. Overall, OSNA showed a sensitivity of 0.69, specificity of 1, accuracy of 88.2%, and stage migration of 8.8%. Compared to those who were OSNA (−), OSNA (+) patients had a greater number of LN metastases (4.8 vs. 0.16, P = 0.04), higher G3 rate (44.4% vs. 4%, P = 0.01), more advanced stage of disease (stage III: 77.8% vs. 16%; P = 0.00) and were more rapidly subjected to adjuvant chemotherapy (39.1 days vs. 50.2 days, P = 0.01).
CONCLUSION
SLN analysis with OSNA in combination with ICG-NIR lymphangiography is feasible and can detect LN involvement in CRC patients. Furthermore, it allows for more accurate staging reducing the delay between surgery and adjuvant chemotherapy.

Keyword

Colorectal cancer; Sentinel lymph node analysis; One-step nucleic acid; Fluorescence; Indocyanine green

MeSH Terms

Chemotherapy, Adjuvant
Colorectal Neoplasms*
Eosine Yellowish-(YS)
Fluorescence*
Hematoxylin
Humans
Indocyanine Green*
Lymph Node Excision
Lymph Nodes*
Lymphography
Neoplasm Metastasis
Sensitivity and Specificity
Eosine Yellowish-(YS)
Hematoxylin
Indocyanine Green
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