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More recommendations for lymph node adequacy in CRC

Posted Dec 07 2009 12:00am

The Dutch National Working Group on Gastrointestinal Cancers has recently released colorectal cancer guidelines which includes a recommendation of a minimum of 10 lymph nodes to establish a negative lymph node status.  At the same time, the group states that "determining the lymph node status of a patient requires evaluation as many lymph nodes as possible using conventional techniques." (emphasis mine

The discussion of this recommendation states that "no definitive criteria were found in the literature regarding the minimum number of examined lymph nodes.  There is no evidence to support 12 lymph nodes, as recommended by TNM." (emphasis mine)

Furthermore, they specifically do not recommend using immunohistochemistry to detect metastases or pre-treatment of mesenteric fat with GEWF-type solutions.  While using the former to detect micrometastases is not common practice, as least in the U.S., the latter is not only fairly common, if not routine in many places (mine included!).  Also, the recent literature also supports the use of these solutions to increase lymph node retrieval, although the utility of the raw node count has been questioned with the data regarding the percentage or proportion of positive:negative nodes (whole other discussion!).

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