Mapping of Sentinel Lymph Node Micrometastasis in Dukes-B Colorectal Carcinoma and Its Clinical Significance

Xiongfei YANG, Tao WANG, Weisheng ZHANG, Lili FENG, Binbin DU, Aili ZHANG


OBJECTIVE     To investigate the detection of sentinel lymph node (SLN) micrometastasis (MM) and the clinical significance in patients with Dukes-B colorectal carcinoma (CRC) using H&E stained slides.
METHODS    In a prospective study of 64 patients with DukesB CRC undergoing radical surgery, routine H&E staining combined with the immunohistochemical SP method was used to detect the expression of the cytokeratin 20 (CK20) and telomerase (TLMA) in 122 SLNs from 61 of the 64 cases. During a 3-year follow up, the patients’ clinicopathologic parameters data, survival and their relationship were collected and analyzed.
RESULTS    i) In 6 out of the 61 cases with successful mapping, 9 SLNs were positive after routine detection using H&E staining. ii ) In the other 55 with negative results from H&E staining, the positive rate of CK20 expression was 27.3% (15/55), and the positive rate of TLMA 21.8% (12/55), at er immunohistochemical examination (IHC) on the SLN.  iii ) Detection by combining the 2 methods showed that the micrometastasis rate was 38.2% (21/55). iv ) The recurrence or metastasis rate of CRC was significantly higher in the Dukes-B patients with sentinel lymph node micrometastasis (SLNMM) (+) than in those with SLNMM (-) ( P  < 0.05), and simultaneously, the survival rate decreased by a large margin in the patients with SLNMM (+), compared to those with SLNMM (-) (P  < 0.05). There were significant differences in the recurrence or metastasis rate of cancer and the survival rate between the Dukes-B patients with SLNMM (-) and the Dukes-C patients (P < 0.05).
CONCLUSION    Examination of anti-CK20 and anti-TLMA using immunohistochemical staining can be used to detect SLNMM, and the combined examination of the 2 can increase the detection rate. The detection of SLNMM can precisely determine the Dukes stage of colorectal carcinoma, which is of help in directing postoperative adjunctive therapy and in assessing prognosis. 


colorectal carcinoma, sentinel lymph node, micrometastasis.

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