Acetone compression improves lymph node yield and metastasis detection in colorectal cancer

Area of Science:

• Oncology
• Pathology
• Surgical Pathology

Background:

• Lymph node status is critical for colorectal cancer prognosis and post-operative management.
• Current guidelines recommend examining at least 12 lymph nodes, but this is often challenging, especially after neoadjuvant therapy.
• Inadequate lymph node detection can lead to understaging and suboptimal patient care.

Purpose of the Study:

• To evaluate the efficacy of acetone compression in enhancing lymph node retrieval from colorectal cancer resections.
• To determine if acetone compression improves the accuracy of pathological nodal staging.
• To assess the impact of acetone compression on the number of detected lymph node metastases.

Main Methods:

• Retrospective analysis of 384 colorectal cancer resections processed between January 2012 and December 2022.
• Comparison of lymph node yield before and after implementing acetone compression.
• Statistical analysis of lymph node counts, detection of metastases, and staging adjustments.

Main Results:

• Acetone compression significantly increased lymph node harvest (p < 0.0001).
• The target of ≥12 lymph nodes was achieved in 98% of specimens after using acetone compression.
• The detection of nodal positive cases increased from 24.7% to 34.1% (p < 0.001) due to additional metastases.
• Acetone compression led to a staging adjustment in 9.4% of cases initially considered nodal negative, prompting recommendations for post-operative therapy.

Conclusions:

• Acetone compression is a reliable and practical method for routine surgical pathology to improve lymph node retrieval in colorectal cancer specimens.
• This technique enhances lymph node sampling adequacy, leading to more reliable nodal staging.
• Improved staging accuracy through acetone compression can significantly impact patient management decisions, including the recommendation of adjuvant therapy.