Brown Henry G, Luckasevic Todd M, Medich David S, Celebrezze James P, Jones Sandra M
Deptartment of Pathology, Allegheny General Hospital, Pittsburgh, PA, USA.
Mod Pathol. 2004 Apr;17(4):402-6. doi: 10.1038/modpathol.3800071.
The adequacy of lymph node dissection of colonic resection specimens influences the clinical and pathologic staging, leading to important postsurgical treatment decisions. Although manual lymph node dissection is the current standard at most institutions, recent statistical studies indicate that all lymph nodes, including those measuring 1-2 mm, should be recovered to be assured of lymph node negative status. Thus, we tested the efficacy of gross dissection by submitting the entire residual mesenteric fat. We analyzed 15 randomly chosen colonic resections (2 pT1, 1 pT2, 11 pT3, 1 pT4). After standard gross dissection of lymph nodes and submission of colonic material for diagnosis, the entire remaining mesenteric material was dehydrated over several days by serial washing in alcohol and acetone. All of the mesenteric tissue was submitted for histology. The average number of nodes found by original gross inspection was 20.8, while the average number of additional nodes found after clearing was 68.6. In all, 83% of the additional nodes were 2.0 mm or less in size. There were seven pN0 cases; one was upstaged by additional findings that may have been artifactual. There were four pN1 cases; three were upstaged to pN2 after submission of the mesenteric material. All four pN2 tumors had additional metastases identified. In all, 75% of all positive nodes were under 2.0 mm in size. In this limited sample, standard gross dissection proved sufficient for most pN0 tumors to remain node negative. However, our findings within the pN1 group show that examination of all of the mesenteric material may be necessary to be assured of correct pN status.
结肠切除标本的淋巴结清扫是否充分会影响临床和病理分期，从而导致重要的术后治疗决策。虽然手动淋巴结清扫是大多数机构目前的标准操作，但最近的统计研究表明，所有淋巴结，包括那些直径为1 - 2毫米的淋巴结，都应被切除以确保淋巴结阴性状态。因此，我们通过提交整个残留肠系膜脂肪来测试大体解剖的效果。我们分析了15例随机选择的结肠切除术（2例pT1，1例pT2，11例pT3，1例pT4）。在对淋巴结进行标准大体解剖并提交结肠材料进行诊断后，通过在酒精和丙酮中连续冲洗数天将整个剩余的肠系膜材料脱水。所有肠系膜组织都送去做组织学检查。最初大体检查发现的淋巴结平均数量为20.8个，而清除后发现的额外淋巴结平均数量为68.6个。总共，83%的额外淋巴结大小为2.0毫米或更小。有7例pN0病例；其中1例因可能是人为因素的额外发现而上调分期。有4例pN1病例；提交肠系膜材料后，3例上调至pN2。所有4例pN2肿瘤都发现了额外的转移灶。总共，所有阳性淋巴结的75%大小在2.0毫米以下。在这个有限的样本中，标准大体解剖证明对大多数pN0肿瘤保持淋巴结阴性是足够的。然而，我们在pN1组中的发现表明，可能需要检查所有肠系膜材料以确保pN状态正确。
