Impact of methylene blue staining in the retrieval of lymph nodes in resected colorectal cancer specimens

Abstract

Adequate lymph node harvest in resected colorectal cancer (CRC) specimens is important in staging and choosing appropriate therapeutic options. The yield of lymph nodes and metastatic nodes by methylene blue dye injection in 30 randomly selected resected CRC specimens was compared with an equal number of CRC specimens (control) with matched grade and stage.The mean number of lymph nodes retrieved in the study group was 22 ± 9 compared to 17 ± 8 in the control group which was statistically significant (P = 0.04).Methylene blue technique is an effective aid in increasing the yield of lymph nodes in the resected CRC specimens.

Sensitivity and specificity of indocyanine green near‐infrared fluorescence imaging in detection of metastatic lymph nodes in colorectal cancer: Systematic review and meta‐analysis

“…Various materials and methods have been used for intraoperative SLN mapping including direct visual identification of SLN after the injection of isosulfan blue dye, patent blue dye, or methylene blue dye; scintigraphy after injection of radiocolloid around the tumor, and recently the use of near‐infrared (NIR) fluorescence after the injection of indocyanine green (ICG) …”

Improved Accuracy of Lymph Node Staging and Long-Term Survival Benefit in Colorectal Cancer With Ex Vivo Arterial Methylene Blue Infiltration

“…Our results are largely consistent with those found in the literature. Application of this method might result in an increase of lymph node yield [9,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Although a tendency for increment could be observed in each subgroup, a statistically significant improvement was documented among rectum cancer cases but not for colonic cases.…”

“…It results in accumulation of the blue dye in the vessels, lymphatic channels and lymph nodes, providing the pathologist with a good color contrast between nodes and surrounding fat tissue. This ex vivo method was first introduced by Märkl et al in 2007, and multiple groups have adopted this approach considering its feasibility and affordability [9,[20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Our study aimed to examine the method of MB injection in a randomized setting within an Eastern European healthcare system.…”

Role of near-infrared fluorescence in colorectal surgery

“…There are various methods for intraoperative mapping of SLNs. Currently, surgeons use direct visualization identification after the injection of dyes such as isosulfan blue[ 39 ], patent blue[ 40 ], methylene blue[ 41 ], or scintigraphy after the injection of radiocolloids around the tumour[ 42 ], and for over ten years, the use of NIRF after the injection of ICG.…”