Preoperative Tattooing and Improved Lymph Node Retrieval Rates From Colectomy Specimens in Patients With Colorectal Cancers

Abstract

Tattooing of colonic lesions at the time of preoperative colonoscopy seems to increase the quality of lymph node analysis. We advocate routine tattooing of all suspicious neoplasms at the time of colonoscopy.

Effect of preoperative colonoscopic tattooing on lymph node harvest in T1 colorectal cancer

“…In our data, the median number of retrieved lymph nodes and the rate of more than 12 retrieved lymph nodes were higher in the tattooing group than that in the non-tattooing group. According to recently published studies, preoperative tattooing increased the number of lymph nodes examined [6][7][8]. A possible explanation for this finding is easier discrimination of lymph nodes containing carbon particles during surgery or pathologic examination.…”

“…Clinicopathological information for age; sex; tumor size; histologic grade; lymphovascular invasion; location of the primary tumor in the proximal colon (cecal, ascending, and transverse colon), distal colon (descending, sigmoid, and rectosigmoid colon), or rectum; pathologic nodal stage; and total number of lymph nodes examined were extracted from our database. Adequate lymph node harvest was defined as retrieval of more than 12 lymph nodes [6]. This study was approved by our Institutional Review Board.…”

“…In addition to localization by PCT, several authors recently reported that PCT could increase the number of nodes examined [6][7][8]. The reason for increased lymph node yield after tattooing was attributed to the fact that India ink-containing lymph nodes can be more easily detected by the surgeon or pathologist (Fig.…”

“…The reason for increased lymph node yield after tattooing was attributed to the fact that India ink-containing lymph nodes can be more easily detected by the surgeon or pathologist (Fig. 1) [6,7]. Examination of an adequate number of nodes is crucial for accurate tumor stage discrimination in colorectal cancer.…”

“…It is well known that patient prognosis in colorectal cancer is influenced by the retrieved number of lymph node [9][10][11] although the exact reason for this phenomenon remains unclear. Stage migration and the effect of extensive lymphadenectomy are suggested as possible explanations [6,12]. Therefore, retrieval of more than 12 lymph nodes is recommended for adequate staging in colorectal cancer [9,13].…”