Lymph node sampling in colorectal cancer: still many lessons to be learned

Lymph node sampling in colorectal cancer: still many lessons to be learned

Bence Kővári, Cord Langner


The tumor stage based on the American Joint Committee on Cancer / Union for International Cancer Control tumor node metastasis (TNM) system is considered the most important prognostic factor for patients with colorectal adenocarcinoma. Clinical decision-making including the application of adjuvant chemotherapy is greatly influenced by the presence of lymph node metastasis. The number of retrieved lymph nodes mainly depends on tumor-related factors, such as tumor size and depth of penetration, as well as procedure-related factors, including the extent and technique of surgical mesocolon/mesorectum removal and the skills and thoroughness of the pathologist. The lymph node ratio, defined as the number of positive lymph nodes divided by the total number of evaluated nodes, is a new marker. It may imply a higher prognostic significance than the absolute number of positive nodes alone. It is of note, that the pathologist’s lymph node harvest is dependent on the size of the lymph nodes. Thus, the diameter of lymph nodes, which are relevant to be histologically evaluated is a frequent matter of debate. The size of the lymph nodes is related to the risk of metastatic involvement, with the larger nodes more commonly positive for metastatic deposits than the smaller ones. However, statistical analysis based on multiple series of lymph nodes so far failed to determine a reliable cut-off value to predict metastatic disease. Thorough specimen dissection and the examination of lymph nodes smaller than 2mm can cause upstaging in approximately 30% of cases, but usually cannot identify additional node positive patients.


Lymph node, colorectal carcinoma, metastasis, prognosis

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