Micrometastasis in colorectal carcinoma: a review.

Lymph node metastasis is the most important predictor of prognosis, after surgery, in colorectal carcinoma. The term "micrometastasis" has evolved from a morphological definition to one that is used with molecular-based techniques. We review the literature to evaluate the significance of detecting micrometastases in colorectal carcinoma, either by morphological or molecular techniques, and address technical difficulties encountered with both. Routine use of immunohistochemistry is not recommended as most studies show little change in staging or prognosis. Radioimmunoguided surgery may prove beneficial, but problems of false positives in benign diseases need to be addressed. Immunohistochemical detection of micrometastatic deposits in bone marrow aspirates holds the most promise for clinical practice. Molecular techniques are more sensitive than immunohistochemistry, but prognostic value needs to be determined. Molecular diagnostics can also determine genetic alterations and mutations that should improve our understanding of metastatic colon cancer and staging accuracy.