Sir Thomas Browne Academic Colorectal Unit, Norfolk and Norwich University Hospital, Norwich, UK.
Royal Berkshire Hospital, Reading, Berkshire, UK.
Histopathology. 2022 Apr;80(5):752-761. doi: 10.1111/his.14600. Epub 2022 Feb 16.
A number of randomised controlled trials (RCT) have compared different techniques to improve lymph node yield (LNY) in colorectal cancer specimens, but data on comparative effectiveness are sparse. Our aim was to compare the relative effectiveness and rank all available techniques. A systematic search of Embase, Cochrane, PubMed and Scopus was performed for randomised trials. Pairwise was meta-analysis performed if more than two homogeneous studies were available for each comparison. Network meta-analysis was used to rank and compare all available techniques. Fifteen studies fulfilled the inclusion criteria. Techniques that were compared included methylene blue (MB), glacial acetic acid, ethanol, distilled water and formaldehyde (GEWF), Carnoy solution (CS), patent blue (PB), formalin, fat clearing (FC) and their combinations. The overall quality of studies was found to be fair. In pairwise meta-analysis MB had a higher lymph node yield weighted mean difference (WMD) = 13.67 (4.83-22.51), P < 0.01, lower number of specimens with fewer than 12 lymph nodes log odds ratio = -1.88 (-2.8, -0.91), P < 0.01 and higher LNY in patients with prior chemoradiotherapy [WMD = 9.11 (3.15, 15.08), P = 0.02] compared to formalin. Evaluation of the network plot revealed a well-connected network. In network meta-analysis MBFC had a higher LNY with [mean difference (MD) 13 and 95% credible interval (CrI) = 2.09-23.91] compared to formalin. MBFC probability of being the best technique for LNY was 91.4%. In network meta-analysis MB did not have a statistically significant difference when compared to formalin. MBFCS seems to be the most effective technique for LNY. Further studies are required to make safe conclusions for outcomes such positive lymph nodes and upstaging.
一些随机对照试验（RCT）比较了不同技术以提高结直肠癌标本的淋巴结检出率（LNY），但关于比较有效性的数据很少。我们的目的是比较相对有效性并对所有可用技术进行排名。对 Embase、Cochrane、PubMed 和 Scopus 进行了系统搜索，以查找随机试验。如果对于每个比较都有超过两项同质研究，则进行成对的荟萃分析。使用网络荟萃分析对所有可用技术进行排名和比较。十五项研究符合纳入标准。比较的技术包括亚甲蓝（MB）、冰醋酸、乙醇、蒸馏水和福尔马林（GEWF）、卡诺氏液（CS）、专利蓝（PB）、甲醛、脂肪清除（FC）及其组合。研究的整体质量被认为是公平的。在成对荟萃分析中，MB 的淋巴结检出率加权均数差（WMD）为 13.67（4.83-22.51），P<0.01，淋巴结少于 12 个的标本数量较少，对数比值比为-1.88（-2.8，-0.91），P<0.01，并且在接受过放化疗的患者中 LNY 更高 [WMD=9.11（3.15，15.08），P=0.02] 与甲醛相比。对网络图的评估显示出一个连接良好的网络。在网络荟萃分析中，MBFC 的 LNY 更高 [平均差异（MD）为 13，95%可信区间（CrI）=2.09-23.91] 与甲醛相比。MBFC 用于 LNY 的最佳技术的概率为 91.4%。在网络荟萃分析中，MB 与甲醛相比没有统计学上的显著差异。MBFCS 似乎是 LNY 最有效的技术。需要进一步的研究来为阳性淋巴结和分期升级等结果得出安全的结论。
