Lymph node revealing solutions in colorectal cancer: should they be used routinely?

J Clin Pathol. 2014 May;67(5):383-8. doi: 10.1136/jclinpath-2013-202146. Epub 2014 Feb 3.

Abstract

The Royal College of Pathologists (RCPath) and College of American Pathologists recommend that at least 12 lymph nodes should be harvested for adequate staging of colorectal carcinoma. Just one nodal tumour deposit upstages the malignancy from pN0 to pN1. This is critically important as node-positive patients (pN1) are considered for adjuvant chemotherapy whereas node-negative patients (pN0) may not be. It is not always easy to harvest the required number, especially in patients with rectal carcinoma who may have received neoadjuvant therapy-an increasingly common treatment. The use of neoadjuvant therapy is known to further decrease the number and size of identifiable lymph nodes within specimens, meaning that the lymph node harvest often fails to reach RCPath guidelines. Lymph node revealing solutions consisting of either single chemicals such as alcohol or acetone or compounds have been investigated to help improve the lymph node harvest in difficult specimens, for example, those received following neoadjuvant therapy. Published research evidence reviewed here suggests that lymph node revealing solutions significantly improve lymph node harvesting, and that glacial acetic acid, ethanol, water and formalin is advantageous in comparison with other revealing solutions in that it is safe, cheap, easy to use and relatively quick. However, the quantity of good evidence is limited and the clinical implications of improving lymph node harvesting require further research.

Publication types

  • Review

MeSH terms

  • Acetic Acid*
  • Chemotherapy, Adjuvant
  • Colorectal Neoplasms / pathology*
  • Colorectal Neoplasms / therapy
  • Ethanol*
  • Ether*
  • Formaldehyde*
  • Guideline Adherence
  • Humans
  • Lymph Node Excision* / standards
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Neoadjuvant Therapy
  • Neoplasm Staging
  • Patient Selection
  • Practice Guidelines as Topic
  • Predictive Value of Tests
  • Tissue Fixation / methods*
  • Tissue Fixation / standards

Substances

  • lymph node revealing solution
  • Ether
  • Formaldehyde
  • Ethanol
  • Acetic Acid