Distribution of Metastatic Affection in Colorectal Carcinoma Using Lymphatic Mapping and
Radiation-Navigated Biopsy of the Sentinel Lymphonode
Duben J.1, Vážan P.3, Bakala J.2, Dudešek B.1, Musil T.1, Hnátek L.1, Hradská K.1, Gatěk J.1
1Chirurgické oddělení Nemocnice Atlas a.s. Zlín, Univerzita Tomáše Bati Zlín, prim. MUDr. J. Gatěk, Ph.D. 2Oddělení nukleární medicíny BN Zlín, prim. MUDr. J. Bakala 3Bioptická a cytologická laboratoř Zlín, vedoucí lékař: MUDr. J. Velecký |
|
Summary:
Aim: The aim is to define distribution of the lymphonode metastatic affection in colorectal carcinoma and to evaluate a new
methodology of lymphatic mapping and the sentinel lymphonode detection during colorectal carcinoma procedures in practice.
Used methods: A method of peroperative lymphatic mapping using a Patentblue method in vivo. Rectoscopic peritumoral
application of a radiocoloid in a two-day or a single-day protocol, scintigraphy, peroperative quants of radioactivity detection
using a gamma probe. Radical or paliative tumor resection. Detection of the sentinel and non-sentinel nodes on a preparation
ex vivo, divided according to levels. The metastatic affection distribution is assessed in three levels, marked U1 – U3, a S1 – S3.
Histopathological examination of the nodes on series sections and, event. immunohistochemistry.
Results: The methods were used in 66 patients. A total of 970 nodes have been examined, with an average of 14.6 nodes/
patient. The metastases quantity decreases with distance from the tumor. The peritumoral levels (U1 a S1) record the highest
rates of metastases. In our patient group, 92% of the metastases were recorded in the S1 level, 4% in the S2 level and 4 % in the
S3 level.
Conclusions: The highest rate of metastases was recorded in the levels, closest to the tumor, therefore, in case of negative
findings of sentinel nodes in the S1 level, the nodes from this level may be closely examined (using the method of series sections
and immunhistochemistry) and the staging be established more precisely.
Key words:
colorectal carcinoma – sentinel lymphonode – radiocoloid – lymphatic mapping
|