Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm

Abstract

A median 17 months follow-up in these patients demonstrated that metastases in small lymph nodes are important in the accurate staging of rectal tumors and that a manual method of searching for small lymph nodes is reliable.

Adenocarcinoma of the Lower Third of the Rectum Surgically Treated With a <10-MM Distal Clearance: Preliminary Results in 35 N0 Patients

“…Lymph nodes were search by manual dissection, as previously described. 12,13 The pathologic stage for the entire series, defined according to the Astler-Coller system, was as follows: 30 (20%) stage B1; 47 (30%) stage B2 (for the total of 77 N0 patients); 13 (9%) stage C1; and 64 (41%) stage C2. The mean number of examined lymph nodes was 36 in stage B1 cases, 46 in stage B2, 37 in stage C1, and 42 in stage C2.…”

A Data Management Approach to Quality Assurance Quality Assurance Using Colorectal Carcinoma Reports From Two Institutionsas a Model

“…2 In addition, the identification of small (ie, <5 mm) lymph nodes in itself is an important event in accurate staging. 22,23 Another advantage of using this type of fat clearance is that the adipose tissue can be retained in this solution overnight for reharvesting the next day without decrement in the histologic features of the lymph nodes. Attention can be directed to the smallest of lymph nodes that were undetectable the previous day if the initial lymph node harvest is considered suboptimal.…”

Adenocarcinoma of the Lower Third of the Rectum: Metastases in Lymph Nodes Smaller Than 5 mm and Occult Micrometastases; Preliminary Results on Early Tumor Recurrence

“…All the surgical specimens were examined by the same pathologist (S Andreola) after fixation in 10% buffered formalin for 24 hours; the regional lymph nodes were searched using a manual technique without previous fat clearing. 2 The metastatic lymph nodes were measured on the histologic slides. Histopathologic examination of the surgical specimen included: the distal resection margin of the rectum, the circumferential resection margin of the mesorectum, and the search for neoplastic vascular invasion.…”

“…The accuracy in identifying the pathologic stage depends on the number of examined lymph nodes and a careful search for metastases in lymph nodes smaller than 5 mm (small lymph nodes). 1,2 There is no agreement whether or not the occult micrometastases detected in the negative lymph nodes, by immunocytochemical staining [3][4][5][6][7][8][9][10] or molecular techniques, 11 really affect the patient out-come. 5-7,9 -11 So, it is questionable if the search for occult micrometastases justifies the use of expensive techniques when many lymph nodes are collected and examined using conventional methods.…”