Department of Pathology, Sørlandet sykehus HF, Kristiansand, Norway.
APMIS. 2011 Jun;119(6):347-55. doi: 10.1111/j.1600-0463.2011.02748.x. Epub 2011 Apr 12.
A review of 1050 pathology reports from colorectal adenocarcinoma specimens examined at the Department of Pathology, Sørlandet sykehus HF, Kristiansand, Norway during the period 1995-2006 revealed a poor performance of most doctors concerning lymph node harvest. A mean of 8.1 nodes per specimen (range 12.3-2.1) and a mean proportion of 22.3% of specimens with ≥12 lymph nodes (range 47.1-0%) were found. A small pilot study was undertaken in 2007 to evaluate the effect of prolonged formalin fixation and the use of a special lymph node fixative [glacial acetic acid, ethanol, water and formaldehyde (GEWF) solution] with regard to the number of retrieved nodes. This showed that one extra day formalin fixation and the use of GEWF solution considerably enhanced the detection of lymph nodes, particularly those of smaller size. Based on these findings, our routines concerning handling of colorectal cancer specimens were changed during 2007. After this time all specimens have been fixed in a mixture of GEWF solution and formalin for at least 48 h and the doctors have been encouraged to find as many lymph nodes as possible. In cases revealing <12 nodes after microscopical examination, the specimens have been re-examined and searched for additional nodes. A review of lymph node retrieval in 423 cases of colorectal cancer during the period 2008-2010 showed that the mean number of nodes per specimen had increased to 16.8 (range 29.0-13.3) and the proportion of specimens with ≥12 nodes to 78.0% (range 96.8-63.6%). Thus, these changes of routines which were easy to implement without significant extra costs have considerably improved lymph node harvest at our department. The use of a special lymph node fixative (e.g. GEWF solution) is highly recommended not only for detection of nodes in colorectal specimens, but also for retrieval of lymph nodes embedded in fat tissue generally.
对挪威索拉伦地区医院（Sørlandet sykehus HF）病理科 1995 年至 2006 年期间 1050 份结直肠腺癌标本的病理报告进行回顾性分析，结果显示大多数医生在淋巴结清扫方面表现不佳。平均每个标本有 8.1 个淋巴结（范围为 12.3-2.1），平均有 22.3%的标本有≥12 个淋巴结（范围为 47.1-0%）。2007 年进行了一项小型试点研究，以评估延长福尔马林固定时间和使用特殊的淋巴结固定液（冰醋酸、乙醇、水和福尔马林（GEWF）溶液）对检出淋巴结数量的影响。结果表明，福尔马林固定时间延长一天和使用 GEWF 溶液可显著增加淋巴结的检出率，尤其是较小淋巴结的检出率。基于这些发现，我们在 2007 年改变了结直肠癌标本处理的常规操作。自那时起，所有标本均在 GEWF 溶液和福尔马林的混合物中固定至少 48 小时，并且鼓励医生尽可能多地寻找淋巴结。在显微镜检查后发现<12 个淋巴结的病例中，对标本进行重新检查并寻找额外的淋巴结。对 2008 年至 2010 年期间 423 例结直肠癌的淋巴结检出情况进行回顾性分析，结果显示每个标本的平均淋巴结数量增加至 16.8（范围为 29.0-13.3），≥12 个淋巴结的标本比例增加至 78.0%（范围为 96.8-63.6%）。因此，这些易于实施且不会增加显著额外成本的常规操作的改变，显著提高了我们科室的淋巴结检出率。强烈推荐使用特殊的淋巴结固定液（如 GEWF 溶液），不仅可用于结直肠标本的淋巴结检测，还可用于一般脂肪组织中嵌入的淋巴结的检出。
