AIMS: The Royal College of Pathologists recommend that a median of at least 12 lymph nodes should be harvested during pathological staging of @entity14 . It is not always easy to harvest the required number, especially in @entity1 with @entity5 receiving neoadjuvant therapy. Lymph node revealing solutions, for example, GEWF, may improve nodal yield. GEWF is safe, cheap and easy to use. METHODS: In a controlled trial, lymph node yields were compared after secondary specimen dissection following either 24   h of further fixation in @entity406 (n=101) or GEWF immersion (n=99). The number, size and @entity5 status of additional lymph nodes identified were compared between groups. Twenty-seven cases that received long-course neoadjuvant therapy were also assessed. RESULTS: Median lymph node yield at primary dissection met national standards overall (19) but also in the long-course neoadjuvant therapy group (13). Lymph nodes were smaller in neoadjuvant cases compared with non-neoadjuvant cases (mean size range 1.3-5.6   mm vs 1.5-8.9   mm). The use of further fixation and GEWF detected more nodes at secondary dissection. The mean number of additional nodes harvested was greater with @entity406 (8.3) than GEWF (7.3). There was no significant difference in the mean size of the additional lymph nodes detected between groups (point estimate 1.02; 95% CI -0.58 to 2.63; p=0.211). Upstaging triggering adjunct chemotherapy occurred in 1% (2/200) of cases. CONCLUSIONS: The routine use of adjunct techniques to identify additional lymph nodes is unnecessary with underlying high-quality dissection practice. Emphasis should be placed upon education and training, spending appropriate time dissecting and ensuring specimens are sufficiently fixed beforehand.

A comparison of @entity406 and GEWF in fixation of XXXX specimens: rates of lymph node retrieval and effect on TNM staging.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity406 :: ('MESH:D005557', 'Chemical') :: ['formalin'] @entity5 :: ('MESH:D009369', 'Disease') :: ['rectal cancer', 'tumour'] @entity14 :: ('MESH:D015179', 'Disease') :: ['colorectal cancer']
@entity14 :: (MESH:D015179,Disease) :: ['colorectal carcinoma']
