Injecting Methylene Blue Into the Inferior Mesenteric Artery Assures an Adequate Lymph Node Harvest and Eliminates Pathologist Variability in Nodal Staging for Rectal Cancer

Kerwel, Therese G.; Spatz, Johann; Anthuber, Matthias; Wünsch, Katharina; Arnholdt, H.; Märkl, Bruno

doi:10.1007/dcr.0b013e31819f28c9

Cited by 39 publications

(53 citation statements)

References 19 publications

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“…Moreover, the usefulness of this technique has been approved by several other groups. [23][24][25][26][27][28][29][30] This study showed again that dramatic improvements are seen with the use of advanced lymph node dissection techniques (Figures 1 and 2). This was especially true in neoadjuvantly treated rectal cancer cases-a situation strongly associated with low lymph node counts.…”

Section: Discussionmentioning

confidence: 61%

“…The technique has been described before. 23,24 In brief, an ex vivo intra-arterial injection of 15-20 ml of methylene blue solution is performed in the fresh or shortly formalin-fixed (r 4 h) specimen. Lymph nodes were then dissected manually after fixing overnight.…”

Section: Advanced Lymph Node Dissectionmentioning

confidence: 99%

“…In another 55 cases, the methylene blue-assisted lymph node dissection technique and fat clearance were combined. 23,24 Sequential Lymph Node Dissection Sequential lymph node dissection was performed in a subset of 94 cases. In these cases, the mesenteric fat of the specimens was divided into three parts: the tumor region, the proximal and the distal parts.…”

Section: Advanced Lymph Node Dissectionmentioning

confidence: 99%

“…In 2007, we introduced the methylene blue-assisted lymph node dissection method as a cheap and simple alternative method to improve lymph node harvest in gastrointestinal cancers. 23,24 The aim of this study was to investigate the effect of an advanced lymph node dissection technique dependent on different clinicopathological factors (age, location, T-stage, therapy, and so on) in a large study group compared with a historical control group of equal size. Moreover, we addressed the question of whether an improved yield is associated with an increase in the node positivity rate and therefore influences the stage-related outcome.…”

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confidence: 99%

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Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer

et al. 2013

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Lymph node staging is of paramount importance for prognosis estimation and therapy stratification in colorectal cancer. A high number of harvested lymph nodes is associated with an improved outcome. Methylene blue-assisted lymph node dissection effectively improves the lymph node harvest and ensures sufficient staging. Now, the effect on node positivity rate and stage-related outcome was investigated. The study cohort with advanced lymph node dissection consisted of 669 colorectal cancer cases of all stages, which were collected between 2007 and 2012. A historical collection of 663 cases investigated with conventional techniques between 2002 and 2004 served as control. Lymph node harvest was dramatically improved in the study group with mean lymph node numbers of 34±17 vs 13±5 (Po0.001) and sufficient staging rates of 98% vs 62% (Po0.001). However, neither the rate of nodal positive cases (37% vs 37%; P ¼ 0.98) nor the rate of N2 cases differed between the two groups (14% vs 13%; P ¼ 0.80). Furthermore, no differences were found concerning the outcome in both groups. The advanced lymph node dissection technique guarantees adequate histopathological lymph node staging in virtually all cases of colorectal cancer and is therefore extremely helpful. The hypothesis that it also provides a higher sensitivity in detecting metastases, however, could be not proved.

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Section: Discussionmentioning

confidence: 61%

Section: Advanced Lymph Node Dissectionmentioning

confidence: 99%

Section: Advanced Lymph Node Dissectionmentioning

confidence: 99%

mentioning

confidence: 99%

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Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer

et al. 2013

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“…Recently, we introduced methylene blueassisted lymph node dissection as a cheap and highly effective method to guarantee optimal lymph node staging in gastrointestinal cancers, with lymph node numbers by far exceeding the general recommendations. [13][14][15][16] This improvement is mainly the result of better visibility of small lymph nodes. Therefore, the question arises as to whether the detection of such small lymph nodes is clinically significant.…”

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confidence: 99%

The clinical significance of lymph node size in colon cancer

et al. 2012

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To date, the clinical value of lymph node size in colon cancer has been investigated only in a few studies. Only in radiological diagnosis is lymph node size routinely recognized, and nodes Z10 mm in diameter are considered pathologic. However, the few studies regarding this topic suggest that lymph node size is not a reliable indicator of metastatic disease. Moreover, we hypothesized that increasing lymph node size is associated with favorable outcome. By performing a morphometric study, we investigated the clinical significance of lymph node size in colon cancer in terms of metastatic disease and prognosis. A cohort of 237 cases with excellent lymph node harvest (mean lymph node count: 33±17) was used. The size distribution in node-positive and -negative cases was almost identical. In all, 151 out of the 305 metastases detected (49.5%) were found in lymph nodes with diameters r5 mm. Only 25% of lymph nodes 410 mm showed metastases. Minute lymph nodes r1 mm were involved only very rarely (2 of 81 cases). In 67% of the cases, the largest positive lymph node was o10 mm. The prognostic relevance of lymph node size was investigated in a subset of 115 stage I/II cases. The occurrence of Z7 lymph nodes that were 45 mm in diameter was significantly associated with better overall survival. Our data show that lymph node size is not a suitable factor for preoperative lymph node staging. Minute lymph nodes have virtually no role in correct histopathological lymph node staging. Finally, large lymph nodes in stage I/II disease might indicate a favorable outcome.

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Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma

Tsai

Crane

Skibber

et al. 2011

Cancer

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BACKGROUND Preoperative chemoradiation for rectal cancer can decrease the number of evaluable lymph nodes. Hence, the prognostic role of lymph node evaluation in patients with rectal cancer who receive preoperative chemoradiation is unclear. The authors of this report evaluated the prognostic impact of the number of lymph nodes examined in patients with rectal cancer who had negative lymph nodes based on the pathologic extent of disease (ypN0) after they received preoperative chemoradiation. METHODS Between 1990 and 2004, 372 patients with nonmetastatic rectal adenocarcinoma received preoperative chemoradiation followed by mesorectal excision and had ypN0 disease. The median radiation dose was 45 gray, and 68% of patients received adjuvant chemotherapy. RESULTS Patients had a median of 7 lymph nodes examined after preoperative chemoradiation. Compared with patients who had ≤7 lymph nodes examined, patients who had >7 lymph nodes had higher 5-year rates of freedom from relapse (86% vs 72%; log-rank P = .005) and cancer-specific survival (95% vs 86%; log-rank P = .0004), but no significant difference was observed in the overall survival rate (87% vs 81%; log-rank P = .07). Multivariate Cox proportional models demonstrated that patients who had >7 lymph nodes examined had a significantly lower risk of relapse (hazard ratio [HR], 0.39; P = .003) and death from rectal cancer (HR, 0.45; P = .04) but a similar risk of all-cause mortality (HR, 0.75; 95% CI, 0.46–1.20; P = .23) compared with patients who had ≤7 lymph nodes examined. CONCLUSIONS The number of lymph nodes examined was associated independently with disease relapse and cancer-specific survival in patients with rectal cancer who had ypN0 disease after receiving preoperative chemoradiation. Hence, the authors concluded that the number of negative lymph nodes examined may be a prognostic factor in patients with rectal cancer who receive preoperative chemoradiation.

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Injecting Methylene Blue Into the Inferior Mesenteric Artery Assures an Adequate Lymph Node Harvest and Eliminates Pathologist Variability in Nodal Staging for Rectal Cancer

Abstract: Staining the lymph nodes with methylene blue dye is an accurate staging technique and reliably produces an adequate harvest.

Cited by 39 publications

References 19 publications

Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer

Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer

The clinical significance of lymph node size in colon cancer

Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma

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