Colorectal Surgical Specimen Lymph Node Harvest: Improvement of Lymph Node Yield with a Pathology Assistant
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Adequate lymph node harvest from colorectal cancer specimens has become a standard of care, influencing both staging and survival. To improve lymph node harvests at our hospital, a pathology assistant was trained to meticulously harvest lymph nodes from colorectal cancer specimens. An analysis of trends in lymph node harvests over time is presented.
The number of harvested lymph nodes from 391 consecutive colorectal cancer pathology reports was retrospectively reviewed from a single community hospital over 8 years (1999–2006). This spanned 4 years prior to the training of the pathology assistant and 4 years after.
From 1999–2002, the mean number of harvested lymph nodes varied from 12.2 to 14.4. The percentage of specimens achieving 12 lymph nodes was 50–67%. From 2003–2006, the mean number of harvested lymph nodes increased to 18.4–20.7, while the percentage of specimens achieving 12 lymph nodes was 83–87%. Both of these improvements achieved statistical significance with p values of <0.00001.
Over time, lymph node harvests at our hospital dramatically improved. The training of a pathology assistant to harvest the lymph nodes from colorectal cancer specimens dramatically affected lymph node harvests and can be a crucial component of pathologic analysis of these specimens.
KeywordsColorectal neoplasms Lymph node excision Pathology Surgical
- 2.Bilimoria KY, Stewart AK, Palis BE, Bentrem DJ, Talamonti MS, Ko CY. Adequacy and importance of lymph node evaluation for colon cancer in the elderly. J ACS 2008;206(2):247–254.Google Scholar
- 6.Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: A secondary survey of Intergroup Trial INT-0089. J Clin Oncol 2003;21(15):2912–2919. doi: 10.1200/JCO.2003.05.062.CrossRefPubMedGoogle Scholar
- 12.Practice NCCN. Guidelines in Oncology. Colon Cancer. V2.2008. NCCN website. www.nccn.org/professionals/physician_gls/PDF/colon.pdf. P.17. Accessed August 5, 2008.
- 13.National Quality Forum Endorsed Commission on Cancer Measures for Quality of Cancer Care for Breast and Colorectal Cancers. American College of Surgeons, Commission on Cancer Website. www.facs.org/cancer/qualitymeasures.html. Accessed August 9, 2008.
- 17.Utah QuickFacts from the US Census Bureau. quickfacts.census.gov/qfd/states/49000.html. Accessed July 22, 2008.
- 18.Decal website. www.decal-bone.com/dissectaid.html. Accessed August 28, 2008.
- 19.Jass JR, O’Brien J, Riddell RH, Snover DC. Association of Directors of Anatomic and Surgical Pathology. Recommendations for the reporting of surgically resected specimens of colorectal carcinoma: Association of Directors of Anatomic and Surgical Pathology. Am J Clin Pathol 2008;129(1):13–23. doi: 10.1309/6UHNC7MAD8KWNAWC.CrossRefPubMedGoogle Scholar
- 20.Rajput A, Skibber J, Engstrom P, Weiser M, Wilson J, Shibata S, et al. D. Schrag for the NCCN Colon/Rectal Outcomes Project. Meeting the 12 lymph nodes (LN) benchmark in colorectal cancer surgery: A comparison of NCCN and SEER data. Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings Vol 25, No 18S (June 20 Supplement), 2007. Abstract 4015.Google Scholar
- 21.Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: Recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 2002;26(2):179–189. doi: 10.1097/00000478–200202000–00004.CrossRefPubMedGoogle Scholar
- 22.Otchy D, Hyman NH, Simmang C, Anthony T, Buie WD, Cataldo P, Church J, Cohen J, Dentsman F, Ellis CN, Kilkenny JW 3rd, Ko C, Moore R, Orsay C, et al. Standards Practice Task Force; American Society of Colon and Rectal Surgeons. Practice parameters for colon cancer. Dis Colon Rectum 2004;47(8):1269–1284. doi: 10.1007/s10350–004–0598–8.CrossRefPubMedGoogle Scholar