Combination probe and dye-directed lymphatic mapping detects micrometastases in early XXXX .

@entity1 @entity5 @entity1711 @entity1710 @entity14 @entity3
Nodal metastasis is the single most important prognostic factor in early @entity14 ( @entity14 ). Lymphatic mapping can identify sentinel nodes for focused histopathologic examination and thereby improve the nodal staging of @entity14 ; however, the optimal technique for identifying sentinel nodes in @entity14 is unclear. We hypothesized that a combination of radiotracer and blue dye would more accurately identify @entity5 -positive sentinel nodes than blue dye alone. Lymphatic mapping was performed in 48 consecutive @entity1 undergoing resection for @entity14 and in two original @entity1 who underwent sentinel node mapping in 1996. Prior to resection, 1% vital blue dye and radiotracer were injected around the @entity5 in the subserosal layer. Nodes were designated as sentinel by blue coloration and/or radioactivity. Lymphatic mapping identified at least one sentinel node in 49 @entity1 . Focused examination of multiple sentinel node sections by means of @entity1710 and @entity1711 and immunohistochemical analysis showed that sentinel nodes accurately predicted the status of the nodal basin in 93.8% (46 of 49) of @entity1 . Of the 19 @entity1 with nodal @entity3 , 11 had macrometastases (>.2 mm), three had micrometastases (between 2 mm and 0.2 mm), and five had @entity5 cells or clusters (<.2 mm) identified by immunohistochemical analysis only. @entity1 had significantly fewer blue/radioactive ("hot") nodes than blue-only nodes (1.38 vs. 2.48 per @entity1 ; P = 0.0001). It is important to note that nodal @entity3 were more common in blue/hot nodes than in blue-only nodes (27.3% [19 of 68] vs. 8.8% [11 of 124]; P = 0.005). Dual-agent lymphatic mapping more accurately identifies sentinel node @entity3 than blue dye alone. In addition, this technique allows a more focused histopathologic examination of these nodes, in conjunction with the revised American Joint Committee on Cancer guidelines, and thereby offers the potential for significant upstaging of @entity14 .
