Effect of modified Davidson's fixative on examined number of lymph nodes and TNM-stage in colon carcinoma

Abstract

Effect of modified Davidson's fixative on examined number of lymph nodes and TNM-stage in colon carcinoma Kelder, W.; Inberg, B.; Plukker, J. T. M.; Groen, H.; Baas, P. C.; Tiebosch, A. T. M. G. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Abstract Aims: We evaluated the effect of modified Davidson's fixative (mDF) on the number of lymph nodes examined and staging in patients with colon carcinoma. Methods: The results of two different fixation methods used in the pathological preparation of the resection specimens were analyzed. A traditional formalin preparation with manual dissection of all nodes was performed in 117 colon specimens between January 2003 and July 2004. After July 2004, the resected specimens of 125 patients was fixated in mDF. Differences in the retrieval and number of nodes and size of suspected nodal metastases were measured. All lymph nodes were stained with conventional H&E methods. Results: The median number of examined nodes increased from 5 (0e17) to 13 (0e35) nodes after the introduction of mDF ( p < 0.001). The type of resection and the T-stage influenced the number of retrieved nodes significantly. The percentage of node-positive cases increased from 30% to 41% ( p ¼ 0.077) with mDF, the median size of the retrieved lymph nodes decreased from 9 mm before to 6 mm after mDF ( p < 0.001) and more micrometastases were found (6% vs. 16%, p ¼ 0.03). Conclusions: With mDF technique more lymph nodes were retrieved in the resected colon specimens. Smaller nodes and more micrometastases were found, leading to more node positive patients.

Lymph node revealing solutions in colorectal cancer: should they be used routinely?

“…Saleki and Haeri40 attributed significance to this finding, stating it to be due to the overall greater number of lymph nodes harvested after secondary dissection. In contrast, five studies showed an increase in metastatic incidence,29 32 36 37 39 but not always with significance 37 39…”

“…3 18 19 22 25 36 39 40 42 44 Some of the more recent studies using GEWF have assessed and attributed statistical significance to this 36 39 40 42. Brown et al 27 found that 83% of additional lymph nodes were ≤2 mm in size.…”

“…Brown et al 27 found that 83% of additional lymph nodes were ≤2 mm in size. Where GEWF is used this may be due to the white colour of lymph nodes which facilitates detection 39. There is ongoing debate regarding the clinical significance of CRC metastases in small lymph nodes.…”

Hospital Lymph Node Examination Rates and Survival After Resection for Colon Cancer

“…They may also differ in their use of mesenteric defatting techniques (eg, soaking specimens in alcohol overnight) for extracting additional lymph nodes. 17 Such differences in practice style would explain why hospitals vary in the number of nodes examined but not in the number of positive nodes identified.…”

Improving lymph node detection in colon cancer in community hospitals and their pathology department in southern Netherlands

“…[25] Refixation of a specimen in a lymph node-revealing solution resulted in a higher detection rate, [26] although it is an extra step for the pathologist. The median number of lymph nodes increased from 5 to 13 [27] and from 10 to 17 [28] with different modified fixatives. Another research group used a blue marking liquid injected into the rectal artery in 24 patients with rectal cancer with 27 lymph nodes examined in the stained group versus 14 in the controls.…”