Colonoscopic Tattooing May Improve Lymph Node Detection and Mapping

Lymph node detection was higher in patients whose lymph nodes were stained black during tattooing for tumor localization.

Colonoscopic tattooing is now commonly performed to mark colorectal cancer (CRC) and endoscopically unresectable polyps for laparoscopic or open surgical resection. Now, investigators evaluate whether colonic tattooing with carbon black could also mark lymph nodes and thus increase their detectability during surgical resection.

In a retrospective study, researchers assessed lymph node detection in 95 patients who underwent colonic tattooing before resection for invasive CRC and 210 controls who did not undergo tattooing before resection in two hospitals in the Netherlands. Researchers also examined the sensitivity of endoscopic tattooing for sentinel node mapping.

Of the 95 patients who underwent tattooing, the median yield of lymph nodes was higher in patients with carbon detected in a lymph node versus those without carbon detected (15 versus 12; P=0.014), and this difference persisted after multivariable analysis that controlled for tumor stage (P=0.002). Among tattooed patients, 71% had at least one lymph node marked, and the median number of carbon-containing lymph nodes per specimen was five. Surgical reports for two patients documented that black (i.e., marked) lymph nodes led to an adjustment in planned resection. With regard to the potential of tattooing for sentinel node mapping, 24 tattooed patients had N1 or N2 stage tumors with carbon-containing lymph nodes. Of these, 20 had tumor involvement in carbon-stained lymph nodes, for a sensitivity of 83%.

CITATION(S):

Bartels SAL et al. The effect of colonoscopic tattooing on lymph node retrieval and sentinel lymph node mapping. Gastrointest Endosc 2012 Oct; 76:793.