Carnoy’s solution enhances lymph node detection: an anatomical dissection study in cadavers

Luz, Diogo Arantes Behling Pereira da; Ribeiro, Ulysses; Chassot, Celso Alberto; Silva, F. de Salles Collet e; Cecconello, Ivan; Corbett, Carlos Eduardo Pereira

doi:10.1111/j.1365-2559.2008.03148.x

Cited by 15 publications

(15 citation statements)

References 6 publications

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“…1) [19]. Our group previously compared CS with 10 % neutral buffered formalin (NBF) following D1 gastrectomy in cadavers, and observed that CS significantly increased the total number of examined LNs [19]. These findings inspired the present study.…”

Section: Introductionsupporting

confidence: 78%

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Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial

et al. 2014

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Background Pathological examination of a minimum of 16 lymph nodes is recommended following surgery for gastric adenocarcinoma, despite this a longer survival is expected when 30 or more lymph nodes are examined. Small lymph nodes are difficult to identify, and fat-clearing solutions have been proposed to improve this, but there is no evidence of their clinical benefit. Methods Fifty D2 subtotal gastrectomy specimens were randomized for fixation in Carnoy's solution (CS) or 10 % neutral buffered formalin (NBF), with subsequent fat dissection. After dissection, the residual fat from the NBF group, instead of being discarded, was immersed in CS and dissected again. Data from 25 D2 subtotal gastrectomies performed before the study were also analyzed. Results The mean number of examined lymph nodes was 50.4 and 34.8 for CS and NBF, respectively (p \ 0.001). Missing lymph nodes were found in all cases from the residual fat group (mean of 16.9), and in eight of them (32 %) metastatic lymph nodes were present; this allowed the upstaging of two patients. Lymph nodes in the CS group were smaller than those in the NBF group (p = 0.01). The number of retrieved lymph nodes was similar among the NBF and Retrospective groups (p = 0.802). Conclusions Compared with NBF, CS increases lymph node detection following gastrectomy and allows a more accurate pathological staging. No influence of the research protocol on the number of examined lymph nodes was observed.

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Section: Introductionsupporting

confidence: 78%

“…It can be used as an LNRS, since the ethanol extracts phospholipids from the cells, allowing the LNs to stand out as pale nodules (Fig. 1) [19]. Our group previously compared CS with 10 % neutral buffered formalin (NBF) following D1 gastrectomy in cadavers, and observed that CS significantly increased the total number of examined LNs [19].…”

Section: Introductionmentioning

confidence: 99%

Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial

et al. 2014

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“…17 All nodal tissue identified after the soaking procedure was sectioned and stained with hematoxylin and eosin. All grossly visible lymph nodes were dissected away from the specimen, sectioned, and stained with hematoxylin and eosin.…”

Section: Pathologymentioning

confidence: 99%

Learning Curve to Lymph Node Resection in Minimally Invasive Esophagectomy for Cancer

Dhamija

Rosen

Dhamija

et al. 2014

Innovations�(Phila)

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Objective Minimally invasive esophagectomy (MIE) is a safe alternative to open approaches, yet the impact of the minimally invasive approach on oncologic efficacy is unclear. The objectives of the current study were to compare lymph node yields and surgical margins during a single-surgeon series to examine the learning curve to oncologic aspects of MIE. Methods A retrospective review of a prospectively maintained institutional database was performed. The sequential MIE experience for esophageal cancer was subcategorized into terciles (first 25 MIEs as early, next 24 as middle, and most recent 24 as later). Results Seventy-three patients underwent MIE for cancer between 2008 and 2013. Complete resections (R0) were performed in 71 cases (93%), and there were no significant differences in the number of complete resections with negative margins during the MIE experience ( P = 0.54). The number of lymph nodes harvested during MIE increased significantly with progressive experience, with a mean of 22, 29, and 28 nodes recovered in the early, middle, and late subgroups, respectively ( P = 0.038). On multivariate analysis, only increasing surgeon experience (1.4-fold increase in nodal yield for the latter two thirds relative to the first third, P = 0.0011) and histology of high-grade dysplasia (0.54-fold decrease in nodal yield relative to adenocarcinoma or squamous cell carcinoma, P = 0.025) were significant predictors of lymph node yield. Conclusions The ability to execute a complete lymphadenectomy during MIE is affected by surgeon experience and improves over time, plateauing after the first 25 cases.

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“…Thus, reliable retrieval determination of the nodal status is a key feature of the pathological investigation of surgical specimens 3. Besides conventional manual dissectioning (MD), gross examination of mesorectal fatty tissue may be assisted by advanced LN preparation techniques: fat clearance using alcohols and xylene4 5 or solvent mixtures such as Carnoy’s solution,6 dye injection into the superior rectal artery7 or complete embedding of the mesorectal tissue 8 9…”

Section: Introductionmentioning

confidence: 99%

Comprehensive lymph node morphometry in rectal cancer using acetone compression

et al. 2015

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Carnoy’s solution enhances lymph node detection: an anatomical dissection study in cadavers

Cited by 15 publications

References 6 publications

Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial

Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial

Learning Curve to Lymph Node Resection in Minimally Invasive Esophagectomy for Cancer

Comprehensive lymph node morphometry in rectal cancer using acetone compression

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