CARNOY'S SOLUTION INCREASES LYMPH NODES COUNT IN COLON CANCER SPECIMENS WHEN COMPARED TO FORMALIN FIXATION: A RANDOMIZED TRIAL

André Roncon Dias, Marina Alessandra Pereira, Evandro Sobroza Mello, Ivan Cecconello, Ulysses Ribeiro-Jr, Sergio Carlos Nahas, André Roncon Dias, Marina Alessandra Pereira, Evandro Sobroza Mello, Ivan Cecconello, Ulysses Ribeiro-Jr, Sergio Carlos Nahas

Abstract

Aim: At least 12 lymph nodes (LNs) should be examined following surgical resection of colon cancer. As it is difficult to find small LNs, fat clearing fixatives have been proposed, but there is no consensus about the best option. The objective of this study was to verify if Carnoy's solution (CS) increases the LN count in left colon cancer specimens.

Methods: A prospective randomized trial (clinicaltrials.gov registration: NCT02629315) with 60 patients with left colon adenocarcinoma who underwent rectosigmoidectomy. Specimens were randomized for fixation with CS or 10% neutral buffered formalin (NBF). After dissection, the pericolic fat from the NBF group was immersed in CS and re-dissected (Revision). The primary endpoint was the total number of LNs retrieved.

Results: Mean LN count was 36.6 and 26.8 for CS and NBF groups, respectively (p=0.004). The number of cases with <12 LNs was 0 (CS) and 3 (NBF, p=0.237). The duration of dissection was similar. LNs were retrieved in all cases during the revision (mean: 19, range: 4-37), accounting for nearly 40% of the LNs of this arm of the study. After the revision, no case was found in the NBF arm with <12 LNs. Two patients had metastatic LNs during the revision (no upstaging occurred).

Conclusion: Compared to NBF, CS increases LN count in colon cancer specimens. After conventional pathologic analysis, fixing the pericolic fat with CS and performing a second dissection substantially increased the number of LNs.

Conflict of interest statement

Conflict of interest: None

Figures

Figure 1 -. Study flowchart.
Figure 1 -. Study flowchart.
Figure 2 -. Surgical specimen and a…
Figure 2 -. Surgical specimen and a millimeter lymph node fixed in Carnoy’s solution (CS group)
Figure 3 -. Relationship between the number…
Figure 3 -. Relationship between the number on lymph node retrieval with (a) the volume and (b) weight of the pericolic fat; and between the duration of the dissection with (c) the pericolic fat volume and (d) weight (r=Pearson correlation coefficient).

References

    1. Ajani JA, In H, Sano T, et al. American Joint Committee on Cancer (AJCC). Cancer Staging Manual. 8. Vol. 17. Springer; 2017. pp. 203 –2 20. Stomach.
    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492.
    1. Czeczko LEA, Ribas C, Czeczko NG, Skare TL, Yamakawa CK, Gionedis G, Vasconcelos C, Bremer FP, Castoldi DF, Gasser M, Waaga-Gasser AM. Are stem cell marker expression and CD133 analysis relevant to differentiate colorectal cancer? Arq Bras Cir Dig. 2021;33(4):e1568. doi: 10.1590/0102-672020200004e1568.
    1. Dias AR, Pereira MA, de Mello ES, Nahas SC, Cecconello I, Ribeiro U., Jr Lymph Node Yield After Neoadjuvant Chemoradiotherapy in Rectal Cancer Specimens: A Randomized Trial Comparing Two Fixatives. Diseases of the colon and rectum. 2018;61(8):888–896. doi: 10.1097/DCR.0000000000001097.
    1. Dias AR, Pereira MA, Mello ES, Zilberstein B, Cecconello I, Ribeiro U., Junior Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2016;19(1):136–142. doi: 10.1007/s10120-014-0443-2.
    1. Fujieda Y, Maeda H, Oba K, Okamoto K, Shiga M, Fujisawa K, Yokota K, Namikawa T, Kobayashi M, Hanazaki K. Factors influencing the number of retrieved lymph nodes after colorectal resection: a retrospective study from a single institute. Int J Clin Exp Pathol. 2018;11(3):1694–1700.
    1. Ghezzi TL, Pereira MP, Corleta OC, Kalil AN. Carnoy solution versus GEWF solution for lymph node revealing in colorectal cancer: a randomized controlled trial. Int J Colorectal Dis. 2019;34(12):2189–2193. doi: 10.1007/s00384-019-03437-5.
    1. Hernanz F, García-Somacarrera E, Fernández F. The assessment of lymph nodes missed in mesenteric tissue after standard dissection of colorectal cancer specimens. Colorectal Dis. 2010;12(7):e57–e60. doi: 10.1111/j.1463-1318.2009.01987.x.
    1. Horne J, Bateman AC, Carr NJ, Ryder I. Lymph node revealing solutions in colorectal cancer: should they be used routinely? J Clin Pathol. 2014;67(5):383–388. doi: 10.1136/jclinpath-2013-202146.
    1. Horne J, Carr NJ, Bateman AC, 2nd Kandala N, Adams J, Silva S, Ryder I. A comparison of formalin and GEWF in fixation of colorectal carcinoma specimens: rates of lymph node retrieval and effect on TNM staging. J Clin Pathol. 2016;69(6):511–517. doi: 10.1136/jclinpath-2015-203281.
    1. Ma XL, Ye JX, Su J, Qi FF, Meng QY, Shi XY. A modified GEWF solution is cost-saving and effective for lymph node retrieval in resected colorectal carcinoma specimens. Pathol Res Pract. 2014;210(9):543–547. doi: 10.1016/j.prp.2014.05.004.
    1. Newell KJ, Sawka BW, Rudrick BF, Driman DK. GEWF solution. Arch Pathol Lab Med. 2001;125(5):642–645. doi: 10.5858/2001-125-0642-GS.
    1. CoA Pathologists. Protocol for the Examination of Specimens From Patients With Primary Carcinoma of the Colon and Rectum. 2017.
    1. Pereira MA, Dias AR, Faraj SF, Cirqueira Cdos S, Tomitao MT, Nahas SC, Ribeiro U, Jr, de Mello ES. Carnoy’s solution is an adequate tissue fixative for routine surgical pathology, preserving cell morphology and molecular integrity. Histopathology. 2015;66(3):388–397. doi: 10.1111/his.12532.
    1. Profeta da Luz MM, Lacerda-Filho A, Demas Alvares Cabral MM, Maciel da Fonseca L, de Almeida Araújo S, de Almeida Sanches SR, Gomes da Silva R. The role of lymph node revealing solution on the improvement of lymph node harvest in colorectal cancer specimens. Colorectal Dis. 2016;18(3):247–254. doi: 10.1111/codi.13098.
    1. Zanatto RM, Santos G, Oliveira JC, Pracucho EM, Nunes AJF, Lopes-Filho GJ, Saad SS. Impact of kras mutations in clinical features in colorectal cancer. Arq Bras Cir Dig. 2020;33(3):e1524. doi: 10.1590/0102-672020200003e1524.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere