Colorectal Cancer and Lymph Nodes: What's Your Number? Does It Matter?

Document Type


Publication Date


Publication Title

American Journal of Clinical Pathology


Failure to identify metastases in lymph nodes (LNs) results in under staging of patients and, consequently, might cause clinicians not to offer adjuvant chemotherapy. Studies have demonstrated inferior survival of patients with colorectal cancer (CRC) with small numbers of LNs assessed. Recent National Cancer Institute guidelines suggest that a minimum of 12 LNs is required to accurately determine whether a patient has positive LNs. This standard is frequently not met. Material and methods: A computer search from 2007 to 2014 was performed with search keywords “colectomy for tumor.” 250 consecutive cases were retrieved and identified in which colon was resected for tumor. Results: 216 cases showed adequate number of lymph nodes, and 34 cases revealed fewer than 12 lymph nodes on the first search. These 34 cases were subjected to second LN retrieval and search, and only 14 cases were identified in which additional lymph nodes were identified, of which only 3 cases show metastatic tumor. However, interesting to note is that, in those 14 cases where extra sections were submitted, the number of identified lymph nodes varied widely from 1 to 22, of which only 3 cases show nodal metastatic tumor (size 0.1-0.3 cm); and surprisingly these new findings did not actually change the clinical stage. Conclusion: This retrospective study from a community hospital shows that, although the number of lymph nodes retrieved on first search is important, and carries prognostic significance and information for the treatment of patient, most of the time the pathologist and pathology assistant are able to identify the available lymph nodes and retrieve them. However there are cases in which some lymph nodes were missed, and extra sections and fat dissolution solution were used to retrieve those lymph nodes; however, these additional findings did not change the original stage achieved at the time of primary LN dissection.





First Page