Ex vivo sentinel lymph node biopsy in colorectal cancer: A feasibility study

T. L. Fitzgerald, M. A. Khalifa, M. Al Zahrani, C. H.L. Law, A. J. Smith

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Background and Objectives: Sentinel lymph node (SLN) biopsy may improve staging of colorectal cancer. We tested the feasibility of ex vivo SLN dissection. Materials and Methods: Patients undergoing resection of a primary colorectal cancer were included in this study. SLN identification involved ex vivo injection of 1 cc isosulfan blue dye subserosally in the colon or submucosally in the rectum on a separate field. SLNs were cut at 2 mm intervals. Three hematoxylin and eosin-stained (HE) sections were prepared in addition to a middle level for cytokeratin immunostaining. Results: Twenty-six patients with varying tumor location and stage were enrolled and the SLN was identified in 88% (23/26) cases. Three failures occurred in patients with rectal cancer. The average number of SLN harvested was 2.5. The status of the nodal basin was accurately predicted in 91% (21/23) of patients. Two false negative sentinel lymph nodes were harvested in 2 of 3 patients with stage III/IV colorectal cancer. The SLN upstaged 2 patients as a result of HE stained step sections (n = 1) and immunostaining (n = 1). Conclusions: This data suggests that ex vivo SLN biopsy is feasible in colorectal cancer. Although ex vivo SLN biopsy does not alter the lymphatic dissection, it may upstage a subset of patients. The ex vivo technique may be less applicable in rectal cancer and false negative results may occur.

Original languageEnglish (US)
Pages (from-to)27-32
Number of pages6
JournalJournal of Surgical Oncology
Issue number1
StatePublished - May 18 2002


  • Immunohistochemistry
  • Staging
  • Step sectioning
  • Ultrastaging


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