Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial

Abstract

Background Pathological examination of a minimum of 16 lymph nodes is recommended following surgery for gastric adenocarcinoma, despite this a longer survival is expected when 30 or more lymph nodes are examined. Small lymph nodes are difficult to identify, and fat-clearing solutions have been proposed to improve this, but there is no evidence of their clinical benefit. Methods Fifty D2 subtotal gastrectomy specimens were randomized for fixation in Carnoy's solution (CS) or 10 % neutral buffered formalin (NBF), with subsequent fat dissection. After dissection, the residual fat from the NBF group, instead of being discarded, was immersed in CS and dissected again. Data from 25 D2 subtotal gastrectomies performed before the study were also analyzed. Results The mean number of examined lymph nodes was 50.4 and 34.8 for CS and NBF, respectively (p \ 0.001). Missing lymph nodes were found in all cases from the residual fat group (mean of 16.9), and in eight of them (32 %) metastatic lymph nodes were present; this allowed the upstaging of two patients. Lymph nodes in the CS group were smaller than those in the NBF group (p = 0.01). The number of retrieved lymph nodes was similar among the NBF and Retrospective groups (p = 0.802). Conclusions Compared with NBF, CS increases lymph node detection following gastrectomy and allows a more accurate pathological staging. No influence of the research protocol on the number of examined lymph nodes was observed.

Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer

“…On the other hand, we only selected patients who completed the nCMT and were submitted to surgery with curative intent, allowing pure survival curves. They were also treated at a cancer referral center, lymph node yield was high, confirming the adequacy of the lymphadenectomy and of the specimen analysis, and also allowing accurate staging . To make the results reproducible, tumor response evaluation was performed based on the percent of tumor mass replaced by fibrosis or residual tumor cells rather than regression systems.…”

“…The paraffin blocks were sliced serially into 4‐mm thickness and stained with hematoxylin and eosin. Carnoy's solution was used in some cases for LN dissection and at least 16 LN were required for the histopathological analysis, with further search in the event of finding less than 16 …”

Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

“…Surgical specimens were fixed in formalin or Carnoy solution 20 . Pathological tumor response was evaluated according to Ryan criteria 21…”

Detection of Occult Lymph Node Tumor Cells in Node-Negative Gastric Cancer Patients

“…For this reason, studies have been conducted in order to improve the "N" stage evaluation, including implementation of "lymph nodes revealing solution" to increase the amount of retrieved nodes and the addition of complementary methods for tumor cells detection in the histopathological diagnostic routine 7 , 8 .…”