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J Clin Pathol 66:18-23 doi:10.1136/jclinpath-2012-201089
  • Original articles

Better retrieval of lymph nodes in colorectal resection specimens by pathologists’ assistants

  1. N M Jiwa1
  1. 1Symbiant Pathology Expert Centre, Alkmaar, The Netherlands
  2. 2Department of Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands
  3. 3Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr N M Jiwa, Symbiant Pathology Expert Centre, Alkmaar, The Netherlands; m.jiwa{at}symbiant.nl
  • Received 12 September 2012
  • Revised 12 September 2012
  • Accepted 12 September 2012
  • Published Online First 19 October 2012

Abstract

Background Errors in surgical pathology are partly due to the increasing workload of pathologists. To reduce this workload, ‘pathologists’ assistants’ (PAs) have been trained to take over some of the pathologists’ recurrent tasks. One of these tasks is the precise examination of ≥10 lymph nodes (LNs), which is of paramount importance to reduce the risk of understaging of colorectal cancer patients.

Aims To evaluate the role of PAs in harvesting LNs in colorectal resection specimens and, by doing so, in improving patient safety.

Methods LN harvest was retrospectively reviewed in 557 pathology reports on colorectal resection specimens collected in two Dutch hospitals from 2008 until 2011.

Results PAs sampled ≥10 LNs in significantly more cases than pathologists did (83.2% vs 60.9% in hospital A and 79.2% vs 67.6% in hospital B) and recovered on average significantly more LNs than pathologists did (18.5 vs 12.2 in hospital A and 16.6 vs 13.2 in hospital B). PAs harvested a significantly higher percentage of LNs <5 mm than pathologists did (64.2% vs 53.7%). The percentages of colon cancer patients eligible for adjuvant chemotherapy due to inadequate LN sampling alone were significantly higher for cases dissected by pathologists than for those dissected by PAs (17.3% vs 1.1% in hospital A and 13.1% vs 3.4% in hospital B)

Conclusions PAs contribute to patient safety since they recover more and, in particular, smaller LNs from colorectal resection specimens than pathologists do. Moreover, they help to reduce costs and morbidity by reducing the number of patients eligible for adjuvant chemotherapy due to inadequate LN sampling alone.