Three-dimensional computer-assisted dissection of pancreatic lymphatic anatomy on human fetuses: a step toward automatic image alignment

  • T. Bardol
  • G. Subsol
  • M.-J. Perez
  • D. Genevieve
  • A. Lamouroux
  • B. Antoine
  • G. Captier
  • M. Prudhomme
  • M. M. Bertrand
Original Article

Abstract

Purpose

Pancreatic cancer is the fourth cause of death by cancer worldwide. Lymph node (LN) involvement is known to be the main prognostic factor. However, lymphatic anatomy is complex and only partially characterized. The aim of the study was to study the pancreatic lymphatic system using computer-assisted anatomic dissection (CAAD) technique and also to update CAAD technique by automatizing slice alignment.

Methods

We dissected three human fetuses aged from 18 to 34 WA. 5-µm serial sections of duodeno-pancreas and spleen blocks were stained (hematoxylin–eosin, hematoxylin of Mayer and Masson trichrome), scanned, aligned and modeled in three dimensions.

Results

We observed a rich, diffuse but not systematized lymphatic network in the peri-pancreatic region. There was an equal distribution of LNs between the cephalic and body–tail portions. The lymphatic vascularization appeared in continuity from the celiac trunk to the distal ends of its hepatic and splenic arterial branches parallel to the nerve ramifications of the celiac plexus. We also observed a continuity between the drainage of the pancreatic head and the para-aortic region posteriorly.

Conclusion

In view of the wealth of peri-pancreatic LNs, the number of LNs to harvest could be increased to improve nodal staging and prognostic evaluation. Pancreatic anatomy as described does not seem to be compatible with the sentinel LN procedure in pancreatic surgery. Finally, we are now able to offer an alternative to manual alignment with a semi-automated alignment.

Keywords

Pancreatic cancer Lymphatic anatomy Lymph node involvement CAAD Automatic image alignment 

Notes

Acknowledgements

Thanks to the University of Montpellier that awarded us a grant to perform this study and to Sarah Kabani for English language assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Laboratory of Experimental Anatomy Faculty of Medicine Montpellier-NimesUniversity MontpellierMontpellierFrance
  2. 2.Visceral and Digestive Surgery DepartmentCHU de Nimes, University Montpellier 1NîmesFrance
  3. 3.Research-Team ICAR, LIRMM CNRSUniversity of MontpellierMontpellierFrance
  4. 4.Department of Medical Genetics, Reference Center for Developmental Abnormalities and Constitutional Bone DiseasesCHRUMontpellierFrance
  5. 5.Genetics and Immunopathology of Inflammatory Osteoarticular DiseasesINSERM UMR1183MontpellierFrance
  6. 6.University of MontpellierMontpellierFrance
  7. 7.Obstetrics and Gynecology DepartmentNîmes University HospitalNîmesFrance
  8. 8.Department of Plastic and Craniofacial Pediatric SurgeryLapeyronie University HospitalMontpellierFrance
  9. 9.Epidemiological Biostatistics and Clinical Research Laboratory, EA2415University of MontpellierMontpellierFrance

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