Pathology Underrates Colon Cancer Extranodal and Nodal Metastases; Ex vivo Radioimmunodetection Helps Staging

• Published in: Clinical cancer research 2007-09, Vol.13 (18), p.5592s-5597s
• Main Authors: SEZEUR, A, CHATELET, F. P, CARVAJAL-GONZALEZ, S, ASKIENAZY, S, TALBOT, J. N, RAIN, J. D, MILHAUD, G, SAUMON, G, BARBET, J, GRUAZ-GUYON, A, CYWINER, Ch, DE LABRIOLLE-VAYLET, Cl, CHASTANG, C, BILLOTEY, Cl, MALAFOSSE, M, GALLOT, D, BETTON, P, MONTRAVERS, F
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Bispecific; Antineoplastic agents; Biological and medical sciences; Cancer staging; Carcinoembryonic Antigen - immunology; Colonic neoplasms; Colonic Neoplasms - diagnostic imaging; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Gastroenterology. Liver. Pancreas. Abdomen; Haptens; Humans; Indium Radioisotopes; Lymph Nodes; Lymphatic Metastasis - diagnostic imaging; Medical sciences; Middle Aged; Neoplasm metastasis; Neoplasm Staging; Oligopeptides - chemistry; Pathology; Pharmacology. Drug treatments; Prognosis; Radioimmunodetection; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors
• ISSN: 1078-0432; 1557-3265
• DOI: 10.1158/1078-0432.CCR-07-1235

Purpose: Colorectal carcinoma is frequently accompanied by small lymph nodes metastases that often escape pathologic examination. We evaluated whether ex vivo radioimmunodetection with the Affinity Enhancement System (AES) could improve detection of mesocolonic metastases. Experimental Design: A bivalent 111 In-labeled hapten was injected (16 patients) 4 days after a bispecific antibody (anticarcinoembryonic antigen, antihapten). Surgery was done 1 to 3 days later, and radioactive uptake in the mesocolon was recorded. Extensive pathologic examination of the mesocolon (reference method) was done after fat dissolution. This method visualizes all lymph nodes but is not in routine use. Results: The reference method disclosed 705 nodes. There was no significant difference between the number of node metastases detected by AES or by the reference method (16 versus 17). Better detection would have been obtained by AES than by routine pathology ( P < 0.01). In addition 12 extranodal metastases were found in this study of which eight were detected by AES. The prognostic importance of such extranodal metastases has been underlined in the literature. Routine pathology combined with AES would have disclosed all node metastases and 86% of total metastases versus 35% by routine pathology alone. Conclusions: Ex vivo radioimmunodetection could improve nodal and extranodal metastases detection in patients with colorectal cancer. Its value for improving pathologic analysis, together with the effect of these small metastases on prognosis, should be further evaluated. The benefit of adjuvant chemotherapy for patients upstaged with radioimmunodection should also be assessed because adjuvant chemotherapy improves the 5-year survival of stage III patients.