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Comprehensive lymph node morphometry in rectal cancer using acetone compression
  1. Andreas H Scheel1,2,
  2. Rebecca A Reineke2,
  3. Thilo Sprenger3,
  4. Suvi Lokka4,
  5. Julia Kitz2,
  6. B Michael Ghadimi3,
  7. Josef Rüschoff4,
  8. Torsten Liersch3,
  9. Peter Middel2,4
  1. 1Institute of Pathology, University Hospital Cologne, Cologne, Germany
  2. 2Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
  3. 3Department of General and Visceral Surgery, University Medical Center Göttingen, Göttingen, Germany
  4. 4Institute of Pathology Nordhessen, Kassel, Germany
  1. Correspondence to Dr Andreas H Scheel, University Hospital Cologne, Institute of Pathology, Kerpener Str. 62, Cologne 50937, Germany; andreas.scheel{at}uk-koeln.de

Abstract

Aims Acetone compression (AC) is an elution compression technique for the comprehensive pathological examination of fatty tissue. Here AC is combined with digital morphometry to evaluate the impact of preoperative (neoadjuvant) chemoradiotherapy (neoCRT) on lymph node (LN) numbers and morphology in locally advanced rectal cancer. AC is compared with complete embedding of the mesorectal fat (whole mesorectal embedding (WME)) to exclude artificial alterations and to the standard technique, manual dissectioning (MD).

Methods 320 rectal cancer specimens were subjected to LN morphometry. Neoadjuvant CRT was applied in 204 specimens. LNs were prepared either with AC (n=138), WME (n=51) or MD (n=131). 8523 LNs were assessed including 530 nodes with metastases.

Results LN prepared by AC and WME showed similar morphologies. AC revealed reduced LN sizes in neoCRT specimens compared with primary resection (2.2; 2.4 mm, p=0.049) while the LN number was comparable (27; 30/specimen). AC yielded 28 LN/specimen on average, MD yielded 22 LN (p<0.001). In neoCRT specimens, MD yielded less LN compared with primary resection (19; 25). MD detected less small LN (<2 mm; MD: 25%; AC: 56%) while 24 of the 135 LN metastases found by AC were ≤2 mm in diameter.

Conclusions AC does not alter LN morphology and is especially suited to retrieve small LN after neoadjuvant CRT of rectal cancer. Neoadjuvant multimodality treatment caused reduced LN sizes while the LN numbers were not affected. When compared with MD, AC proved more reliable in the retrieval of LN from rectal cancer specimens after neoCRT.

  • RECTAL CANCER
  • SURGICAL PATHOLOGY
  • LYMPH NODES
  • METASTASIS

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