The Morphometry of Lymph Node Metastases after Acetone Compression

The Morphometry of Lymph Node Metastases after Acetone Compression

Rebecca Alice Reineke

Doctoral thesis

Date of Examination: 2015-09-23

Date of issue: 2015-09-23

Advisor: Middel, Peter Dr.

Referee: Middel, Peter Dr.

Referee: Grade, Marian Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-0023-9627-B

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Abstract

English

Lymph node status is the most important prognostic factor in patients with rectal carcinoma and over the years, different methods for lymph node harvest have been introduced. The present study examines efficiency of three different methods for histopathological workup in rectal cancer specimens: Whole Mesorectal Embedding (WME), Acetone Compression (AC) and Manual Dissectioning (MD). Also, the effect of AC on lymph node morphometry and the morphometry of lymph nodes after radiochemotherapy is examined. The results show that AC resulted in the harvest of significantly more and smaller lymph nodes than MD (mean number of nodes per case: 28 vs 22 nodes per patient and a mean lymph node size of 2.27mm vs 3.36mm), while proving to be almost as thorough as the more extensive and time-consuming WME method. AC did not result in alteration of the lymph node morphometry as morphometric parameters in the WME and AC group showed to be comparable. Results also showed that lymph nodes are larger if infiltrated and smaller after preoperative radiochemotherapy (RCT). While MD resulted in harvesting signicifantly fewer nodes in patients treated with RCT, AC succeeded in reaching the UICC minimum of harvesting at leat 12 nodes per patient to a satisfactory extent (in 93.5%of cases) and allowed for a sufficient lymph node harvest both in patients treated with RCT and patients who were primarily operated. AC proved to be a realiable, feasible method that is suitable for routine workup of CRC specimens, both in patients treated neoadjuvantly and patients who were primarily operated.

Keywords: Lymph node morphometry