Department of Surgery, Haraldsplass Deaconal Hospital, Bergen, Norway.
APMIS. 2011 Feb;119(2):127-34. doi: 10.1111/j.1600-0463.2010.02702.x. Epub 2010 Dec 1.
There are good indications that the number of lymph nodes found in the specimen after resections for colon cancer somehow has a bearing on prognosis. Many factors have been reported in the literature to influence lymph node retrieval. We wanted to assess these closer with special focus on the pathology handling process in our own practice. A range of international literature was reviewed to study what has been found to influence lymph node harvest. A questionnaire was sent to 13 renowned national and international institutions to explore their handling of the colon cancer specimens to obtain a histological diagnosis. A retrospective, hospital audit was undertaken to examine if the number of lymph nodes and staging after examinations of the specimens varied between individual pathologists. In the literature, tumour and patient characteristics, as well as the surgeon and the pathologist, are found to be influential, but it is difficult to ascertain which ones are truly essential. Fat solvents were found by several to increase the lymph node yield, although some also opposed this finding. Our questionnaire showed some variations in the routines of each Department. A junior pathologist was more likely to inspect the specimen first hand and not more than half employed specific lymph node detection strategies while three of 13 did not seek a minimum number of lymph nodes. Still every department had implemented a standard procedure for such examinations. The internal audit showed without doubt that the devotion of the pathologist secured significantly more lymph nodes from the specimen and this may also have detected more stage III cancers. Several tumour and individual patient characteristics, surgical approach and specimen handling may influence lymph node yield and theoretically, TNM staging. Our investigation specifically suggests that tissue handling by pathologists may be a prominent factor in lymph node harvest from colon cancer specimens.
有很好的迹象表明，结肠癌切除术后标本中发现的淋巴结数量在某种程度上与预后有关。已有文献报道了许多影响淋巴结检出的因素。我们希望更密切地评估这些因素，特别关注我们自己实践中的病理处理过程。我们回顾了一系列国际文献，以研究哪些因素会影响淋巴结的采集。我们向 13 个著名的国内外机构发送了一份问卷，以探讨他们对结肠癌标本的处理方式，以获得组织学诊断。我们还进行了一项回顾性医院审计，以检查在检查标本后，每个病理学家之间的淋巴结数量和分期是否存在差异。在文献中，肿瘤和患者特征，以及外科医生和病理学家被发现是有影响的，但很难确定哪些是真正重要的。一些人发现脂肪溶剂可以增加淋巴结的产量，但也有人反对这一发现。我们的问卷显示，每个科室的常规操作都存在一些差异。初级病理学家更有可能直接检查标本，而且只有不到一半的人采用了特定的淋巴结检测策略，而 13 个科室中有 3 个科室没有寻求最低数量的淋巴结。不过，每个科室都已经为这些检查实施了标准程序。内部审计无疑表明，病理学家的投入可以从标本中获得更多的淋巴结，这也可能发现更多的 III 期癌症。肿瘤和个体患者特征、手术方法和标本处理等因素可能会影响淋巴结的产量，理论上也会影响 TNM 分期。我们的调查特别表明，病理学家的组织处理可能是从结肠癌标本中获取淋巴结的一个重要因素。
