Role of methylene blue in detecting the sentinel lymph node in colorectal cancer: <em>In vivo</em> vs. <em>ex vivo</em> technique

Staniloaie,Daniel; Budin,Constantin; Vasile,Danut; Iancu,George; Ilco,Alexandru; Voiculescu,Daniel Iulian; Trandafir,Alexandra Florina; Ammar,Tarek; Suliman,Emel; Suliman,Emine; Dragoş,Dorin; Tanasescu,Maria-Daniela

doi:10.3892/etm.2021.10995

Role of methylene blue in detecting the sentinel lymph node in colorectal cancer: In vivo vs. ex vivo technique

Authors:
- Daniel Staniloaie
- Constantin Budin
- Danut Vasile
- George Iancu
- Alexandru Ilco
- Daniel Iulian Voiculescu
- Alexandra Florina Trandafir
- Tarek Ammar
- Emel Suliman
- Emine Suliman
- Dorin Dragoş
- Maria-Daniela Tanasescu
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Affiliations: Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Discipline of Obstetrics and Gynecology, Filantropia Clinical Hospital Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 011171 Bucharest, Romania, 1st Department of General Surgery, Bucharest Emergency University Hospital, 050098 Bucharest, Romania, Department 3 ‑ Complementary Sciences, Discipline of Medical Informatics and Biostatistics, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
Published online on: November 24, 2021 https://doi.org/10.3892/etm.2021.10995
Article Number: 72
Copyright: © Staniloaie et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The identification of sentinel lymph nodes is a valuable oncological method, which aims at mapping lymphatic drainage and has the advantage of correctly staging the disease and assessing prognosis. Lymph node invasion is an important prognostic feature. In colorectal cancer, lymphadenectomy is not influenced by the positive or negative status of the sentinel lymph node. The identification of lymph nodes with possible invasion by staining the primary tumor with methylene blue can lead to improved staging and management. In other words, the consequent administration of neoadjuvant therapy (chemotherapy) to the appropriate patients may result in lower recurrence rates. Thus, the aim of the present study was to use methylene blue to identify the sentinel node/nodes in colorectal cancer and to determine whether the dye‑capturing nodes were invaded by the tumor. This is a non‑randomized prospective study, in which 26 patients with colon cancer with surgical indication were enrolled. Two types of methods were utilized: in vivo (16 patients) and ex vivo (10 patients). The identification rate was 75% for the in vivo technique and 60% for the ex vivo technique, resulting in a 69.26% overall identification rate. Of 18 patients with sentinel lymph nodes identified using dye, routine histological examination detected metastases in 6 (33.33%) of these patients. In conclusion, further research should be conducted into how the clinical application of sentinel node detection can be employed in colorectal cancer.

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1	Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A and Bray F: Global cancer statistics 2020. GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 71:209–249. 2021.PubMed/NCBI View Article : Google Scholar
2	Hokkam E, El-Kammash S, Abdelaziz A, Farrag S, Fathy H and Gomaa A: Assessment of sentinel lymph node biopsy in colon cancer and its impact on staging. Journal of Surgery. 4:36–40. 2016.
3	O'Connell JB, Maggard MA and Ko CY: Colon cancer survival rates with the new American joint committee on cancer sixth edition staging. J Natl Cancer Inst. 96:1420–1425. 2004.PubMed/NCBI View Article : Google Scholar
4	Carrara A, Motter M, Amabile D, Pellecchia L, Moscatelli P, Pertile R, Barbareschi M, Decarli NL, Ferrari M and Tirone G: Predictive value of the sentinel lymph node procedure in the staging of non-metastatic colorectal cancer. Int J Colorectal Dis. 35:1921–1928. 2020.PubMed/NCBI View Article : Google Scholar
5	Gould E, Winship T, Philbin P and Kerr H: Observations on a ‘sentinel node’ in cancer of the parotid. Cancer. 13:77–78. 1960.PubMed/NCBI View Article : Google Scholar
6	Cabanas RM: An approach for the treatment of penile carcinoma. Cancer. 39:456–466. 1977.PubMed/NCBI View Article : Google Scholar
7	Joosten JJ, Strobbe LJ, Wauters CA, Pruszczynski M, Wobbes T and Ruers TJ: Intraoperative lymphatic mapping and the sentinel node concept in colorectal carcinoma. Br J Surg. 86:482–486. 1999.PubMed/NCBI View Article : Google Scholar
8	Andersen HS, Bennedsen ALB, Burgdorf SK, Eriksen JR, Eiholm S, Toxværd A, Riis LB, Rosenberg J and Gögenur I: In vivo and ex vivo sentinel node mapping does not identify the same lymph nodes in colon cancer. Int J Colorectal Dis. 32:983–990. 2017.PubMed/NCBI View Article : Google Scholar
9	Braat AE, Oosterhuis JW, de Vries JE and Tollenaar RA: Lymphatic staging in colorectal cancer: Pathologic, molecular, and sentinel node techniques. Dis Colon Rectum. 48:371–383. 2005.PubMed/NCBI View Article : Google Scholar
10	Fitzgerald TL, Khalifa MA, Al Zahrani M, Law CH and Smith AJ: Ex vivo sentinel lymph node biopsy in colorectal cancer: A feasibility study. J Surg Oncol. 80:27–32. 2002.PubMed/NCBI View Article : Google Scholar
11	Albayrak Y, Oren D, Gündoğdu C and Kurt A: Intraoperative sentinel lymph node mapping in patients with colon cancer: Study of 38 cases. Turk J Gastroenterol. 22:286–292. 2011.PubMed/NCBI View Article : Google Scholar
12	Minhas JS: Lymph node correlations and thresholds in colorectal cancer specimens. Gastrointest Cancer Res. 5 (3 Suppl 1)(S31)2012.
13	Huynh KT and Bilchik AJ: Sentinel lymph node biopsy and nodal ultrastaging in colorectal cancer. Cancer J. 21:11–16. 2015.PubMed/NCBI View Article : Google Scholar
14	Elmorsi T: Equilibrium isotherms and kinetic studies of removal of methylene blue dye by adsorption on to miswak leaves as a natural adsorbent. J Environmental Protection. 5:817–827. 2011.
15	Cahill RA: What's wrong with sentinel node mapping in colon cancer? World J Gastroenterol. 13:6291–6294. 2007.PubMed/NCBI View Article : Google Scholar
16	Mulsow J, Winter DC, O'Keane JC and O'Connell PR: Sentinel lymph node mapping in colorectal cancer. Br J Surg. 90:659–667. 2003.PubMed/NCBI View Article : Google Scholar
17	Van Schaik PM, van der Linden JC, Ernst MF, Gelderman WA and Bosscha K: Ex vivo sentinel lymph node ‘mapping’ in colorectal cancer. Eur J Surg Oncol. 33:1177–1182. 2007.PubMed/NCBI View Article : Google Scholar
18	Wong JH, Steineman S, Calderia C, Bowles J and Namiki T: Ex vivo sentinel node mapping in carcinoma of the colon and rectum. Ann Surg. 233:515–521. 2001.PubMed/NCBI View Article : Google Scholar
19	Stojadinovic A, Allen PJ, Protic M, Potter JF, Shriver CD, Nelson JM and Peoples GE: Colon sentinel lymph node mapping: practical surgical applications. J Am Coll Surg. 201:297–313. 2005.PubMed/NCBI View Article : Google Scholar
20	Chan SH, Ng C and Looi LM: Intraoperative methylene blue sentinel lymph node mapping in colorectal cancer. ANZ J Surg. 9:775–779. 2008.PubMed/NCBI View Article : Google Scholar
21	Märkl B, Schaller T, Krammer I, Cacchi C, Arnholdt HM, Schenkirsch G, Kretsinger H, Anthuber M and Spatz H: Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer. Mod Pathol. 9:1246–1254. 2013.PubMed/NCBI View Article : Google Scholar
22	Ceranic MS, Kecmanovic DM, Pavlov MJ, Nale DP, Micev MT, Kovacevic PA and Stamenkovic AB: Validation and feasibility of ex vivo sentinel lymph node ‘mapping’ by methylene blue in colorectal cancer. Hepatogastroenterology. 57:1113–1118. 2010.PubMed/NCBI
23	Park JS, Chang IT, Park SJ, Kim BG, Choi YS, Cha SJ, Park ES and Kwon GY: Comparison of ex vivo and in vivo injection of blue dye in sentinel lymph node mapping for colorectal cancer. World J Surg. 3:539–546. 2009.PubMed/NCBI View Article : Google Scholar
24	Resch A and Langner C: Lymph node staging in colorectal cancer: Old controversies and recent advances. World J Gastroenterol. 46:8515–8526. 2013.PubMed/NCBI View Article : Google Scholar
25	Frasson M, Faus C, Garcia-Granero A, Puga R, Flor-Lorente B, Cervantes A, Navarro S and Garcia-Granero E: Pathological evaluation of mesocolic resection quality and ex vivo methylene blue injection: What is the impact on lymph node harvest after colon resection for cancer? Dis Colon Rectum. 2:197–204. 2012.PubMed/NCBI View Article : Google Scholar
26	Liu J, Huang P, Zheng Z, Chen T and Wei H: Modified methylene blue injection improves lymph node harvest in rectal cancer. ANZ J Surgery. 4:247–251. 2017.PubMed/NCBI View Article : Google Scholar
27	Bembenek A, String A, Gretschel S and Schlag PM: Technique and clinical consequences of sentinel lymph node biopsy in colorectal cancer. Surg Oncol. 17:183–193. 2008.PubMed/NCBI View Article : Google Scholar
28	Balcangiu-Stroescu AE, Tănăsescu MD, Diaconescu AC, Răducu L, Bălan DG, Mihai A, Tănase M, Stănescu II and Ionescu D: Diabetic nephropathy: A concise assessment of the causes, risk factors and implications in diabetic patients. Rev Chim Buchar. 69:3118–3121. 2018.
29	Timofte D, Mandita A, Balcangiu-Stroescu AE, Balan DG, Raducu L, Tanasescu MD, Diaconescu AC, Dragos D, Cosconel CI, Stoicescu SM, et al: Hyperuricemia and cardiovascular diseases- clinical and paraclinical correlations. Rev Chim Buchar. 70:1045–1046. 2019.
30	Tong GJ, Zhang GY, Liu J, Zheng ZZ, Chen Y, Niu PP and Xu XT: Comparison of the eighth version of the American joint committee on cancer manual to the seventh version for colorectal cancer: A retrospective review of our data. World J Clin Oncol. 9:148–161. 2018.PubMed/NCBI View Article : Google Scholar
31	Di Berardino S, Capolupo GT, Caricato C and Caricato M: Sentinel lymph node mapping procedure in T1 colorectal cancer: A systematic review of published studies. Medicine (Baltimore). 98(e16310)2019.PubMed/NCBI View Article : Google Scholar
32	Ong ML and Schofield JB: Assessment of lymph node involvement in colorectal cancer. World J Gastrointest Surg. 8:179–192. 2016.PubMed/NCBI View Article : Google Scholar
33	Freitas AHA, Wainstein AJA and Nunes TA: Ex vivo sentinel lymph node investigation in colorectal cancer. J Coloproctol. 33:16–21. 2013.
34	Oh SY, Kim DY, Kim YB and Suh KW: Clinical application of sentinel lymph node mapping in colon cancer: In vivo vs. ex vivo techniques. Ann Surg Treat Res. 87:118–122. 2014.PubMed/NCBI View Article : Google Scholar