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

Abstract


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.


Keywords


Lymph node, colorectal carcinoma, metastasis, prognosis

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References


Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on 16/01/2017.

Brierley JD, Gospodarowicz M, Wittekind C eds., TNM Classification of Malignant Tumours, 8th Edition, Wiley Blackwell; 2017

Ong ML, Schofield JB. Assessment of lymph node involvement in colorectal cancer. World J Gastrointest Surg. 2016;8:179-192.

Fielding LP, Arsenault PA, Chapuis PH, Dent O, Gathright B, Hardcastle JD, et al. Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). J Gastroenterol Hepatol 1991; 6: 325-344

Cserni G, Vinh-Hung V, Burzykowski T. Is there a minimum number of lymph nodes that should be histologically assessed for a reliable nodal staging of T3N0M0 colorectal carcinomas? J Surg Oncol. 2002;81:63-69.

Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007 21;99:433-441.

Resch A, Langner C. Lymph node staging in colorectal cancer: Old controversies and recent advances World J Gastroenterol. 2013 14;19:8515-8526.

Loughrey MB, Quirke P, Shepherd NA. Dataset for colorectal cancer histopathology reports. The Royal College of Pathologists; 2014

de Burlet KJ, van den Hout MF, Putter H, Smit VT, Hartgrink HH. Total number of lymph nodes in oncologic resections, is there more to be found? J Gastrointest Surg. 2015;19:943-948.

Gehoff A, Basten O, Sprenger T, Conradi LC, Bismarck C, Bandorski D, et al. Optimal lymph node harvest in rectal cancer (UICC stages II and III) after preoperative 5-FU-based radiochemotherapy. Acetone compression is a new and highly efficient method. Am J Surg Pathol 2012;36:202-213.

Märkl B, Schaller T, Krammer I, Cacchi C, Arnholdt HM, Schenkirsch G, et al. Methylene blue-assisted lymph node dissection technique is not associated with an increased detection of lymph node metastases in colorectal cancer. Mod Pathol 2013;26:1246-1254.

Rössler O, Betge J, Harbaum L, Mrak K, Tschmelitsch J, Langner C. Tumor size, tumor location, and antitumor inflammatory response are associated with lymph node size in colorectal cancer patients. Mod Pathol. [In press].

Cserni G. The influence of nodal size on the staging of colorectal carcinomas. J Clin Pathol. 2002;55:386-390.

Märkl B, Rößle J, Arnholdt HM, Schaller T, Krammer I, Cacchi C, et al. The clinical significance of lymph node size in colon cancer. Mod Pathol 2012;25:1413-1422.

Nagtegaal ID, Quirke P. Colorectal tumour deposits in the mesorectum and pericolon; a critical review. Histopathology. 2007;51:141-149.


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