Pedro Gus

Sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal: early experience.

PURPOSE This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal. METHODS Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3). RESULTS Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal. CONCLUSIONS The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.

Sentinel Lymph Node Procedure in Patients With Epidermoid Carcinoma of the Anal Canal

AbstractPURPOSE: This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal. METHODS: Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3). RESULTS: Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal. CONCLUSIONS: The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.

Avaliação do desempenho da colonografia tomográfica computadorizada (colonoscopia virtual) no diagnóstico de pólipos colorretais

BACKGROUND: Computed tomographic colonography has been proposed for detection of colorectal polyps instead of colonoscopy in colorectal cancer screening programs. AIM: To evaluate the performance of computed tomographic colonography in the detection of colorectal polyps with colonoscopy used as the gold standard. METHODS: We prospectively studied 20 patients at high risk for colorectal neoplasia (14 men and 6 women; mean age, 55 years and 59 years). Computed tomographic colonography was performed immediately before colonoscopy. We inserted a rectal balloon catheter and insufflated the colon with room air to the level that a good distension was observed. Twenty milligrams of hioscin was given immediately before computed tomographic imaging of the abdomen and pelvis in order to minimize the degree of smooth-muscle spasm and peristalsis and to reduce the patients discomfort. RESULTS: Computed tomographic colonography images were considered satisfactory in all cases. Colonoscopy detected 85 polyps in 19 of 20 patients (95%). All the observed polyps were successfully removed and examined histologically. The radiological examination correctly identified 8 of 10 polyps 10 mm or more in diameter, 2 of 19 (18,2%) with 5-9 mm, and just 1 of 53 5 mm. Eight (47%) were correctly identified on computed tomographic colonography. None of the neoplasias <5 mm were identified on colonography. Nineteen patients preferred colonoscopy in the event of having to repeat on of the two examinations. CONCLUSION: For the detection of colorectal polyps, computed tomographic colonography seems to be useful only when the result is positive, as the negative results of this examination cannot eliminate the presence of these lesions.

Fatores prognósticos e sobrevida no adenocarcinoma primário de reto

OBJETIVO: Avaliar a sobrevida e fatores clinico-patologicos relacionados ao adenocarcinoma de reto. METODOLOGIA: Foram revisados 112 prontuarios de pacientes com adenocarcinoma de reto quanto a: idade, sexo, antigeno carcino-embrionico, curabilidade da cirurgia, seguimento, recidiva, sobrevida e histopatologia do tumor. Para analise da sobrevida, utilizou-se o metodo de Kaplan-Meyer. Nas analises bivariada e estratificada, P N1) e recidiva. A classificacao de Dukes e a diferenciacao tumoral foram fatores prognosticos independentes, bem como a penetracao do tumor na parede retal e o comprometimento linfonodal, quando excluida a classificacao histopatologica. CONCLUSAO: Alem da diferenciacao tumoral, os fatores prognosticos identificados correspondem aos niveis dos sistemas de estadiamento vigentes.

Colonoscopia com magnificação de imagem no diagnóstico de carcinoma colorretal invasivo da submucosa na polipose adenomatosa familiar

O desenvolvimento da colonoscopia com magnificacao de imagem possibilitou o estudo detalhado da mucosa colonica e o diagnostico diferencial entre lesoes neoplasicas e nao-neoplasicas, a partir da observacao dos pit patterns. Os resultados sao comparaveis a estereomicroscopia, sendo possivel, assim, presumir o diagnostico histologico. Foi realizada colonoscopia com magnificacao de imagem em paciente portadora de polipose adenomatosa familiar, demonstrando-se com este metodo, a diversidade de lesoes polipoides benignas e as apresentacoes morfologicas do câncer colorretal precoce. Nesta paciente, a avaliacao por magnificacao (videocolonoscopio FUJINON 410 - CM ¾ 40X), combinada a cromoscopia com indigo carmine 0,4%, demonstrou ampla variedade de lesoes distribuidas por todo o colon: lesao de espalhamento lateral no ceco com padrao IIIL + IV, polipos subpediculados e sesseis distribuidos pelo colon com padrao tipo IIIL, polipo subpediculado no colon transverso com diâmetro aproximado de 2,0 cm e padrao IV + V, lesoes plano-elevadas tipo IIIL e no colon sigmoide lesao IIa + IIc, com padrao V de Kudo. A avaliacao dos pit patterns de lesoes no colon transverso e sigmoide permitiu o diagnostico endoscopico de lesao com invasao de submucosa.The development of colonoscopy with image magnification has enable to study the colonic mucosa in detail and to do differential diagnosis between neoplastic and non-neoplastic lesions from the observation of pit patterns. The results are comparable to stereomicroscopy being possible to predict the histologic diagnosis. In a patient with familial adenomatous polyposis magnifying colonoscopy was performed and this method demonstrated a wide variation of benign polypoid lesions and the morphological features of early colorectal cancer. In this patient, the evaluation by image magnification, together with indigo carmin 0.4% chromoscopy, showed a wide variety of lesions in the colon and rectum: laterally spreading tumor in the cecum, with IIIL + IV pits, subpediculate polyp in the transverse colon with approximately 2.0 cm diameter and IV + V pits, flat elevated lesions IIIL type, and in the sigmoid colon IIa + IIc lesion with V type of Kudos classification were observed. The evaluation of pit patterns of the lesions in the transverse and sigmoid colon has enable to do the endoscopic diagnosis of the lesion with submucosal invasion.The development of colonoscopy with image magnification has enable to study the colonic mucosa in detail and to do differential diagnosis between neoplastic and non-neoplastic lesions from the observation of pit patterns. The results are comparable to stereomicroscopy being possible to predict the histologic diagnosis. In a patient with familial adenomatous polyposis magnifying colonoscopy was performed and this method demonstrated a wide variaton of benign polypoid lesions and the morphological features of early colorectal cancer. In this patient, the evaluation by image magnification, together with indigo carmin 0,4% chromoscopy, showed a wide variety of lesions in the colon and rectum: laterally spreading tumor in the cecum, with IIIL + IV pits, subpediculate polyp in the transverse colon with approximately 2,0 cm diameter and IV + V pits, flat elevated lesions IIIL type, and in the sigmoid colon IIa + IIc lesion with V type of Kudos classification were observed. The evaluation of pit patterns of the lesions in the transverse and sigmoid colon has enable to do the endoscopic diagnosis of the lesion with submucosal invasion.