Injecting Methylene Blue Into the Inferior Mesenteric Artery Assures an Adequate Lymph Node Harvest and Eliminates Pathologist Variability in Nodal Staging for Rectal Cancer
Injecting Methylene Blue Into the Inferior Mesenteric Artery Assures an Adequate Lymph Node Harvest and Eliminates Pathologist Variability in Nodal Staging for Rectal Cancer
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DOI：
10.1007/dcr.0b013e31819f28c9
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发表时间：
2009-05-01
影响因子：
3.9
通讯作者：
Maerkl, Bruno
中科院分区：
文献类型：
--
作者：
Kerwel, Therese Gannon;Spatz, Johann;Maerkl, Bruno
目的：美国癌症联合委员会建议直肠癌患者至少检查12个淋巴结，以获得准确的分期。尽管如此，几项研究表明，结节收获是高度可变的，而且往往不够充分。本研究旨在确定与标准病理淋巴清扫术相比，亚甲蓝染色法是否能更好、更准确地获取结节。方法：将50例一期可切除直肠癌患者随机分为两组，一组为标准结节切除术组，另一组为肠系膜下动脉注射亚甲蓝组。结果：染色组的平均淋巴结收获数为30+/-13.5，未染色组为17+/-11(P<；0.001)。染色组每例至少发现12个结节。在未染色组中，25例中有7例(28%)不符合12个结节的最低标准(P<；0.01)。在染色组的病理学家之间，收获时没有发现差异(P<；0.05)，但在未染色组的病理学家之间检测到差异(P=0.6)。脂肪清除后，未染色组有1例转移，而染色组无转移。结论：亚甲蓝染色法是一种准确的分期技术，可可靠地获得足够的收获。
PURPOSE: The American Joint Committee on Cancer recommends examination of a minimum of 12 lymph nodes in rectal cancer for accurate staging. Despite this, several studies have demonstrated that nodal harvest is highly variable and often inadequate. This study was designed to determine if staining the nodes with methylene blue dye produced a better and more accurate harvest in comparison with standard pathologic lymph node dissection.METHODS: Fifty patients with primary resectable rectal cancer were randomly assigned to undergo a standard nodal harvest or a harvest after ex vivo injection of the inferior mesenteric artery with methylene blue. A fat clearance technique was subsequently used to identify the maximum possible number of lymph nodes and metastasis.RESULTS: The average lymph node harvest was 30 +/- 13.5 in the stained group and 17 +/- 11 in the unstained group (P < 0.001). At least 12 nodes were identified in every case in the stained group. In the unstained group, 7 of 25 cases (28 percent) did not meet the minimum criteria of 12 nodes (P < 0.01). Among the pathologists for the stained group, no difference was found in the harvest (P < 0.05), but variability was detected between the pathologists in the unstained group (P = 0.6). After fat clearance, one case in the unstained group was upstaged, whereas no cases in the stained group were upstaged.CONCLUSIONS: Staining the lymph nodes with methylene blue dye is an accurate staging technique and reliably produces an adequate harvest.