Impact of using a lymph node revealing solution in surgical specimens for pathological staging of gastric cancer

Abstract

Introduction:Lymph node (LN) metastasis is a major staging criterion of gastric cancer (GC). GC prognosis is associated with the number of metastatic LNs.Objectives:To evaluate the impact of using a lymph node revealing solution (LRS) in gastrectomy specimens.Materials and methods:prospective study in 30 gastrectomy specimens (19 men, average age of 59.5; 11 women, average age of 66.1) for pathological tumor, node, metastasis (TNM) staging. After LN dissection according to the routine procedures (conventional method [CM]), the tissue was emerged in LRS: a mixture containing 65% ethanol, 20% ether, 5% acetic acid, and 10% formalin solution (10%), for 36 hours with 3 changes. A new LN dissection was performed. The number of LNs obtained from both methods was compared and analyzed. The number of metastatic and non-metastatic LNs was determined.Results:From 1,005 (33.5/specimen) dissected LNs, 657 of which (21.9/specimen) by the CM, and 348 (11.6/specimen) after using LRS (p = 0.0002), metastases were detected in 272 LNs (9.2/case), 211 of which (7.0/specimen) were found with the CM, and 61 (2.0/specimen) after using LRS (p = 0.0028). The number of LNs increased 53.0% with LRS, and the number of metastatic LNs was 28.9% higher. The pN classification changed in 5 (16.7%) of the 30 specimens, and in stage grouping in 4 (13.3%) analyzed cases.Conclusion:The use of LRS in gastrectomy specimens is simple, enables dissection, increases the number of LNs, and occasionally changes pN staging and stage grouping.

Keywords

• câncer gástrico
• linfonodos
• dissecção
• solução reveladora de linfonodos