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Sentinel Lymph Node Biopsy and Nodal Ultrastaging in Colorectal Cancer

Huynh, Kelly T. MD; Bilchik, Anton J. MD, PhD, FACS

doi: 10.1097/PPO.0000000000000093

The tumor status of the regional lymph nodes is the most important prognostic indicator in colorectal cancer (CRC), as it is in other solid tumors. Sentinel lymph node biopsy (SLNB), which has profoundly impacted the treatment of melanoma and breast cancer, has been applied in CRC in an attempt to improve nodal staging accuracy. The challenge lies in identifying patients who have tumor-negative nodes but are at high risk of regional or distant failure and therefore may benefit from adjuvant chemotherapy. Because standard pathological analysis of lymph nodes may incorrectly stage colon cancer, multiple studies have investigated nodal ultrastaging based on identification and immunohistochemical and/or molecular assessment of the sentinel node. This review focuses on the technique of SNLB, its feasibility and validity, and the controversies that remain regarding the clinical significance of nodal ultrastaging in CRC.

From the Department of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA.

The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Cancer Institute or the National Institutes of Health.

Conflicts of Interest and Source of Funding: Supported by grant 2R01 CA90848-05A2 from the National Cancer Institute and by funding from the California Oncology Research Institute, Los Angeles, CA.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Reprints: Anton Bilchik, MD, PhD, FACS, John Wayne Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA. E-mail:

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