The Effect of Formalin Fixation on Resection Margins in Colorectal Cancer

Lam, David; Kaneko, Yui; Scarlett, Adam; D’Souza, Basil; Norris, Richard H.; Woods, Rodney

doi:10.1177/1066896919854159

Cited by 15 publications

(18 citation statements)

References 29 publications

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“…Secondly, lymph nodes scored in-vivo were located throughout the whole mesorectum and distal mesocolon and part of those could have remained in situ after surgery. Thirdly, formalin fixation could have interfered with the translation from in-vivo to ex-vivo MR, since it can lead to shrinkage and may alter anatomical references compared to the in-vivo situation [33,34]. Fourthly, the challenging part in linking ex-vivo MRI to pathological examination was the translation from 3D to a 2D pathological work-up [27].…”

Section: Tablementioning

confidence: 99%

USPIO-enhanced MRI of lymph nodes in rectal cancer: A node-to-node comparison with histopathology

Stijns

Philips

Nagtegaal

et al. 2021

European Journal of Radiology

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To evaluate the initial results of predicting lymph node metastasis in rectal cancer patients detected invivo with USPIO-enhanced MRI at 3 T compared on a node-to-node basis with histopathology. Methods: Ten rectal cancer patients of all clinical stages were prospectively included for an in-vivo 0.85 mm 3 isotropic 3D MRI after infusion of Ferumoxtran-10. The surgical specimens were examined ex-vivo with an 0.29 mm 3 isotropic MRI examination. Two radiologists evaluated in-vivo MR images with a classification scheme to predict lymph node status. Ex-vivo MRI was used for MR-guided pathology and served as a key link between invivo MRI and final histopathology for the node-to-node analysis. Results: 138 lymph nodes were detected by reader 1 and 255 by reader 2 (p = 0.005) on in-vivo MRI with a median size of 2.6 and 2.4 mm, respectively. Lymph nodes were classified with substantial inter-reader agreement (κ = 0.73). Node-to-node comparison was possible for 55 lymph nodes (median size 3.2 mm; range 1.2-12.3), of which 6 were metastatic on pathology. Low true-positive rates (3/26, 11 % for both readers) and high true negative rates were achieved (14/17, 82 %; 19/22, 86 %). Pathological re-evaluations of 20 lymph nodes with high signal intensity on USPIO-enhanced MRI without lymph node metastases (false positives) did not reveal tumor metastasis but showed benign lymph node tissue with reactive follicles. Conclusions: High resolution MRI visualizes a large number of mesorectal lymph nodes. USPIO-enhanced MRI was not accurate for characterizing small benign versus small tumoral lymph nodes in rectal cancer patients. Suspicious nodes on in-vivo MRI occur as inflammatory as well as metastatic nodes.

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Section: Tablementioning

confidence: 99%

USPIO-enhanced MRI of lymph nodes in rectal cancer: A node-to-node comparison with histopathology

Stijns

Philips

Nagtegaal

et al. 2021

European Journal of Radiology

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“…The rates of shrinkage in different tissues ranged between 2.7-57%. [13][14][15][16][17][18] This wide range of tissue shrinkage in different organs and tumours might be related to the histopathological properties of that tissue. Even the intracellular and extracellular fluid and protein composition of tissues might affect the shrinkage rate of formalin.…”

Section: Discussionmentioning

confidence: 99%

The shrinkage effect of formalin on renal cell carcinoma: Does it change the stages?

et al. 2022

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Objective: To determine the shrinkage effect of formalin on renal cell carcinoma. Method: The retrospective study was conducted from October to November 2020 at Tekirdag Namil kemal University, Turkey and comprised all radical and partial nephrectomy cases performed by a single surgeon in a single clinic between January 2014 and August 2020. Preoperative images and postoperative pathology were reviewed by the same clinician. Preoperative longest tumour diameter of radiological images and pathological specimens measured after formalin fixation shrinkage were compared, and the effect of the difference between the two measurements on the circumference of the tumour was examined. The formalin related shrinkage rates of renal tumours according to the tumour size and the tumour types were also analysed. Data was analysed using SPSS 20. Results: Of the 101 cases, 58(57.4%) were of radical and 43(42.6%) of partial nephrectomy. Also, there were 77(76.2%) renal cell carcinoma cases, 22(21.8%) benign renal tumours and 2(1.9%) had other malignant tumours. There were 59(58.4%) males and 42(41.6%) females with an overall mean age of 58.1±12,2 years (range: 30-82 years). The mean radiological size of the renal tumours was 55.3±30.4mm and it was 52.9±31.6mm at pathological examination (p>0.05). Conclusion: Formalin fixation of tissues post-surgery caused a difference between the radiological and pathological dimensions. Though the difference was no significant, under-staging due to the shrinkage post-surgery should be considered. Key Words: Renal tumours, Tissue shrinkage, Formalin, radiological dimension, Pathological dimension. ---Continue

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“…Briefly, tissues were fixed in 4% paraformaldehyde and paraffin embedded. Tissue shrinkage of up to 20% occurs artificially when the tissue is processed into paraffin blocks [ 18 – 20 ]. All tissue blocks were completely worked up in steps of 200 μm thickness, and cut into 2–3 μm slides being stained with hematoxylin/eosin.…”

Section: Methodsmentioning

confidence: 99%

Anatomy of the neural fibers at the superior mesenteric artery—a cadaver study

Reinehr

Vuille‐dit‐Bille

Soll

et al. 2022

Langenbecks Arch Surg

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Purpose Most surgeons perform right-sided semicircular clearance of the superior mesenteric artery (SMA) nerve plexus for pancreatic head carcinoma, presuming a linear course of the SMA nerve fibers. The hypothesis was that the SMA nerve plexus fibers follow a non-linear course, and the goal of the present study was to assess the neural fibers distribution along the SMA. Methods The course of neural fibers along the retropancreatic and suprapancreatic SMA was assessed in 7 cadavers. Results In the retropancreatic course of the vessel, the main nerve cords branch and form a large number of finer nerve branches performing an anti-clockwise rotation of slightly less than 90° around the SMA. Finer nerve branches are located rather close to the vessel, while the main nerve cords are localized in the loose connective tissue of the peripheral parts of the vascular sheath. Nerve fibers around the suprapancreatic SMA run as two main nerve cords framing the artery on the right lateral-ventral and the left lateral to lateral-dorsal side. Conclusion The rotation of the nerve fiber around the SMA indicates that a more radical resection of at least 180° of neural tissue around the SMA might be required to achieve tumor clearance in pancreatic cancer with perineural invasion at the uncinate margin.

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The Effect of Formalin Fixation on Resection Margins in Colorectal Cancer

Cited by 15 publications

References 29 publications

USPIO-enhanced MRI of lymph nodes in rectal cancer: A node-to-node comparison with histopathology

USPIO-enhanced MRI of lymph nodes in rectal cancer: A node-to-node comparison with histopathology

The shrinkage effect of formalin on renal cell carcinoma: Does it change the stages?

Anatomy of the neural fibers at the superior mesenteric artery—a cadaver study

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