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Lymphknotenpräparation bei kolorektalen Karzinomen

Ex-vivo-Methylenblau-Injektion als neue Technik zur Lymphknotendarstellung

Lymph node preparation in colorectal cancer

Ex vivo methylene blue injection as a novel technique to improve lymph node visualization

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Zusammenfassung

Von der UICC wird die Mindestzahl von 12 Lymphknoten für ein adäquates Lymphknoten-Staging kolorektaler Karzinome gefordert. Zahlreiche Autoren befürworten jedoch die Untersuchung einer größeren Anzahl von Lymphknoten und empfehlen hierfür verschiedene Techniken wie beispielsweise die Fettaufhellung. Wir stellen in dieser Studie eine neue Technik zur Ex-vivo-Lymphknotenmarkierung mittels intraarterieller Methylenblau-Injektion bei Kolonkarzinomen vor. 14 markierte Fälle wurden darin mit 14 konventionell bearbeiteten Fällen aus unserem Archiv verglichen. Die Lymphknotenausbeute differierte in den beiden Gruppen mit im Mittel 28±7 vs. 14±3 hochsignifikant (p<0,001) zugunsten der Methylenblau-Gruppe. Der größte Unterschied ergab sich in der besonders relevanten Diametergruppe von 2–4 mm (191 vs. 70 Lymphknoten). In der Ungefärbt-Gruppe war zum Erreichen einer adäquaten Zahl die zusätzliche Einbettung von Fettgewebe in 6 Fällen notwendig. Die Methylenblau-Markierung ist eine neue und hoch effektive Methode zur Verbesserung der Lymphknotenpräparation bei kolorektalen Karzinomen.

Abstract

The UICC requires investigation of a minimum of 12 lymph nodes for adequate lymph node staging in colorectal cancer. Despite that, many authors recommend investigation of a larger number, and different techniques, such as fat clearance, have therefore been developed. In this study we introduce a novel technique involving ex vivo lymph node staining with intraarterial methylene blue injection in colon cancer. We compared 14 cases in which methylene injection was used with 14 cases from our records in which conventional investigation techniques were applied. The lymph node harvest differed highly significantly (p<0.001) between the two groups, with average numbers of 28±7 and 14±3 in the methylene blue group and the unstained group, respectively. The largest difference occurred in the size group 2–4 mm (191 vs 70 lymph nodes). In 6 cases in the unstained group additional embedding of fatty tissue was necessary to reach an adequate number of investigated lymph nodes. Methylene blue injection is a novel and highly effective method that will improve lymph node preparation in colorectal cancer.

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Danksagung

Unser besonderer Dank gilt Herrn Dr. Ernst Leipprand für Unterstützung und fachlichen Rat.

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Märkl, B., Kerwel, T., Jähnig, H. et al. Lymphknotenpräparation bei kolorektalen Karzinomen. Pathologe 29, 274–279 (2008). https://doi.org/10.1007/s00292-007-0950-6

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  • DOI: https://doi.org/10.1007/s00292-007-0950-6

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