Use of the sentinel lymph node to determine metastases of gastrointestinalmalignancies: A word of caution

Identifying the sentinel lymph node has been shown to carry prognostic and therapeutic implications in the surgical treatment of solid tumors. Recentl y, sentinel lymphadenectomy has been described for gastrointestinal maligna ncies, but its clinical value remains uncertain. We describe the case of a patient with appendiceal carcinoid who underwent a right hemicolectomy 4 mo nths after appendectomy, out of concern over residual local or regional dis ease. One sentinel lymph node was identified in the colonic mesentery using the blue dye technique. This sentinel node and 35 others were negative for metastases, but one lymph node not identified through blue dye carried evi dence for micrometastatic disease on hematoxylin and eosin (H&E) and immuno histochemical chromogranin stains. The case raises some issues about the va lue and limitations of sentinel lymph node biopsies in gastrointestinal can cer. Aspects related to technique, learning curve, gastrointestinal lymphat ic drainage patterns, the impact of prior operations, and the limited thera peutic implications compared to cutaneous or subcutaneous solid malignancie s are discussed. We conclude that at this point in time, the information ob tained from biopsies of sentinel lymph nodes during the surgical treatment of gastrointestinal cancer should be utilized with due caution. J. Surg. On col. 1999;71:239-242. (C) 1999 Wiley-Liss, Inc.