Context: The nodal stage of colorectal cancers is prognostically important. Most current staging guidelines concentrate on the minimum number of evaluated lymph nodes required for an adequate node-negative stage.
Objective: To evaluate the distance of the lymph nodes from the primary tumors as a possible qualitative feature that could help pathologists select between these nodes.
Design: Prospective analysis of 100 colorectal carcinoma specimens.
Setting: Department of Pathology of a medium-sized teaching hospital.
Patients: Consecutive patients with colorectal cancer.
Interventions: Nodes abluminal from the tumor and the adjacent bowel segments were recovered in 4 fractions (A through D) in 100 colorectal carcinoma specimens.
Main outcome measures: Distribution of metastatic nodes in fractions A through D, and their influence on nodal stage.
Results: All tumors but 1 were classified correctly as node-negative or node-positive on the basis of fraction A (nodes abluminal from the tumor and from the 1-cm-long segments proximal and distal to the tumor). All tumors but 1 were appropriately classified as pN0, pN1, or pN2 on the basis of fractions A and B (nodes abluminal from the tumor and from the 3-cm-long segments proximal and distal to the tumor).
Conclusions: Lymph nodes should be recovered from fractions A and B, and if 3 nodes are reported positive, additional nodes should be sought to determine the extent of nodal involvement. This qualitative restriction of the grossing protocol may reduce the time spent in recovering nodes from colorectal carcinoma resection specimens.