A comparison of formalin and GEWF in fixation of colorectal carcinoma specimens: rates of lymph node retrieval and effect on TNM staging

Horne, Joanne; Carr, Norman J.; Bateman, A C; Kandala, N-B; Adams, Jody; Silva, Sónia; Ryder, Isobel

doi:10.1136/jclinpath-2015-203281

Cited by 7 publications

(6 citation statements)

References 47 publications

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“…A total number of 432 studies were identified, 15 of which RCTs [14][15][16][17][18][24][25][26][27][28][29][30][31][32][33] with a total of 1445 specimens fulfilled the inclusion criteria (Figure 1). Randomised studies reporting on gastric malignancies were excluded.…”

Section: Resultsmentioning

confidence: 99%

Comparative effectiveness of pathological techniques to improve lymph node yield from colorectal cancer specimens: a systematic review and network meta‐analysis

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 99%

Comparative effectiveness of pathological techniques to improve lymph node yield from colorectal cancer specimens: a systematic review and network meta‐analysis

et al. 2022

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“…A further study from this group demonstrated the importance of detecting small (<5 mm diameter) nodes and the effect of systematic fat blocking on nodal stage. A recent prospective controlled study in colorectal specimens showed that extended fixation and a lymph node revealing solution increased node yield but did not result in upstaging 13. The authors concluded that high-quality dissection practice obviated the need for lymph node revealing techniques.…”

Section: Discussionmentioning

confidence: 99%

Fat clearance of upper gastrointestinal resection specimens increases lymph node yield and may result in nodal upstaging

2018

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IntroductionLymph node retrieval and quantification is an important element in staging upper gastrointestinal cancers. Our department introduced fat clearance for oesophagectomy and gastrectomy specimens in 2014. This study assessed the impact of this change on lymph node yield and upstaging.MethodsWe reviewed histopathology data for upper gastrointestinal resection specimens. Patient demographics, clinical, macroscopic and microscopic data were compared with a historical cohort who did not undergo fat clearance.ResultsOf 158 patients, 133 resection specimens received fat clearance resulting in a significantly higher lymph node yield than the historical cohort (22 vs 13 lymph nodes, p<0.0001). Fat clearance found additional positive nodes in 24.1% of patients and increased the number of cases achieving a minimum node yield of 15. Nodes found by fat clearance caused upstaging in 15% of the cohort.DiscussionFat clearance increases node yield in upper gastrointestinal resection specimens and may cause nodal upstaging.

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“…However, this is not an easy task, and finding small LNs may be challenging. Fat clearing solutions have been proposed to facilitate the detection of LNs 7 , 10 , 11 , 12 . A clear benefit is seen when LN count is low 11 , 12 , but apparently the impact is reduced or absent if the LN yield is high 7 , 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Fat clearing solutions have been proposed to facilitate the detection of LNs 7 , 10 , 11 , 12 . A clear benefit is seen when LN count is low 11 , 12 , but apparently the impact is reduced or absent if the LN yield is high 7 , 10 . CS is a validated and inexpensive tissue fixative that improves detection and staging accuracy of LN in rectal cancer following chemotherapy 14 .…”

Section: Discussionmentioning

confidence: 99%

“…The detection of LN in colorectal specimens is laborious and time-consuming. To facilitate and improve the detection of LN, tissue fixatives with fat clearing ability have been proposed, but there is no consensus about the best option or their clinical value 7 , 9 , 10 , 11 , 12 , 15 . In a randomized trial, Carnoy’s solution (CS, 60% ethanol + 30% chloroform + 10% glacial acetic acid) substantially increased LN count and improved staging accuracy in rectal cancer specimens after chemoradiation therapy when compared to 10% neutral buffered formalin (NBF) 4 .…”

Section: Introductionmentioning

confidence: 99%

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Carnoy’s Solution Increases Lymph Nodes Count in Colon Cancer Specimens When Compared to Formalin Fixation: A Randomized Trial

Dias

Pereira

Mello

et al. 2022

ABCD, arq. bras. cir. dig.

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- BACKGROUND: At least 12 lymph nodes (LNs) should be examined following surgical resection of colon cancer. As it is difficult to find small LNs, fat clearing fixatives have been proposed, but there is no consensus about the best option. AIM: The objective of this study was to verify if Carnoy’s solution (CS) increases the LN count in left colon cancer specimens. METHODS: A prospective randomized trial (clinicaltrials.gov registration: NCT02629315) with 60 patients with left colon adenocarcinoma who underwent rectosigmoidectomy. Specimens were randomized for fixation with CS or 10% neutral buffered formalin (NBF). After dissection, the pericolic fat from the NBF group was immersed in CS and re-dissected (Revision). The primary endpoint was the total number of LNs retrieved. RESULTS: Mean LN count was 36.6 and 26.8 for CS and NBF groups, respectively (p=0.004). The number of cases with <12 LNs was 0 (CS) and 3 (NBF, p=0.237). The duration of dissection was similar. LNs were retrieved in all cases during the revision (mean: 19, range: 4-37), accounting for nearly 40% of the LNs of this arm of the study. After the revision, no case was found in the NBF arm with <12 LNs. Two patients had metastatic LNs during the revision (no upstaging occurred). CONCLUSION: Compared to NBF, CS increases LN count in colon cancer specimens. After conventional pathologic analysis, fixing the pericolic fat with CS and performing a second dissection substantially increased the number of LNs.

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A comparison of formalin and GEWF in fixation of colorectal carcinoma specimens: rates of lymph node retrieval and effect on TNM staging

Abstract: The routine use of adjunct techniques to identify additional lymph nodes is unnecessary with underlying high-quality dissection practice. Emphasis should be placed upon education and training, spending appropriate time dissecting and ensuring specimens are sufficiently fixed beforehand.

Cited by 7 publications

References 47 publications

Comparative effectiveness of pathological techniques to improve lymph node yield from colorectal cancer specimens: a systematic review and network meta‐analysis

Comparative effectiveness of pathological techniques to improve lymph node yield from colorectal cancer specimens: a systematic review and network meta‐analysis

Fat clearance of upper gastrointestinal resection specimens increases lymph node yield and may result in nodal upstaging

Carnoy’s Solution Increases Lymph Nodes Count in Colon Cancer Specimens When Compared to Formalin Fixation: A Randomized Trial

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