Should lymph nodes from colorectal cancer resection specimens be processed in their entirety?

To quantify the benefit of processing each lymph node in its entirety in colorectal cancer specimens.

391 consecutive cases were examined retrospectively to assess how often cases were upstaged to node positive disease by examining each node in its entirety.

7 out of 391 patients were upstaged by this method. However, of those patients, approximately three could have been detected by chance. Therefore, approximately 1% of cases were correctly upstaged. However, six of these seven patients also had at least one additional adverse prognostic factor, and would otherwise have been considered high risk Dukes' B cases.

Processing all slices of each lymph node significantly increases laboratory workload and is of minimal clinical benefit.