THE BIOPSY OF THE SENTINEL LYMPH NODE IN COLORECTAL CANCER. LITERATURE REVIEW
Abstract:
Colorectal cancer (CRC) is the most common tumour of the digestive tract, both in women and
men, having a high mortality rate due to local recurrence and metastases. In patients with colon cancer,
the rate of survival is strongly correlated with the status of the lymph nodes. Patients with no metastatic
nodules (TNM stages I and II) have a five-year survival rate of 70-80%, whereas patients in stage III
have a survival rate of only 45-50%.(1) The presence of lymph node metastases indicates the use of
adjuvant therapy in such patients resulting in an increase in the survival rate to 5 years with
approximately 10%.(2) Despite favourable prognosis in patients with colon cancer without lymph node
metastases, 20-30% of them will nevertheless relapse after undergoing curative resection.(3) These
patients are likely to have lymph node metastases that were not detected by using the standard method,
or as a result of inadequate lymphadenectomy, or insufficient histological examination.(4) Current
guidelines recommend the examination of 12 lymph nodes (LN) for the proper staging of patients with
colorectal cancer.(5) Goldstein et al. argue that proper staging requires 6-18 LN.(6) Further scrutiny of
LN, through immunohistochemistry and the RT-PCR reaction, can reveal small tumour deposits that
were not detected by conventional examination. Several authors report a lower survival rate when LN
micrometastases were detected.(7,8,9,10) Since the examination of all LN is time-consuming and
expensive, examining only sentinel lymph nodes (SLN) could be helpful. SLN have the greatest potential
of developing metastases, and their evaluation is more cost-effective and more efficient. Moreover, the
intraoperative nodular mapping can enable the detection of aberrant lymphatic drainage pathways,
which leads to a more extensive resection
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