Carnoy's solution fixation with compression significantly increases the number of lymph nodes yielded from colorectal cancer specimens

• Published in: Journal of surgical oncology Vol. 119; no. 6; pp. 766 - 770
• Main Authors: Flynn, Sean M., Burchette, Raoul J., Ghassemi, Majid, Ratner, Oleg, Mandel, Danielle, Tomassi, Marco J., Klaristenfeld, Daniel D.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2019
• Subjects: Biopsy; Cancer surgery; Carnoy's solution; Colorectal cancer; colorectal cancer staging; lymph node compression; lymph nodes; Lymphatic system; Patients; Carnoy's solution; colorectal cancer; lymph nodes; lymph node compression; colorectal cancer staging
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25372

Background and Objectives Carnoy's fixation and compression represents a novel technique to enhance lymph node evaluation and accuracy of staging after colorectal cancer resection. Methods This study was performed in all adults undergoing colorectal cancer operations by Kaiser Permanente surgeons at two separate facilities. Patients were assigned to either location based upon surgeon and patient availability. One group of patients had their lymph nodes examined with current standard manual technique (MT). The other group had their specimens fixed with Carnoy's solution and then compressed (CT) to assess for lymph nodes. Results A total of 157 patients were enrolled. Seventy‐eight patient specimens underwent MT and 79 patient specimens underwent the new compression technique (CT). CT resulted in a significant increase in total lymph node yield per specimen (37.6 ± 18.5 nodes with CT vs 18.9 ± 8.8 nodes with MT; P < 0.0001). CT also resulted in sufficient lymph node sampling (>12 nodes) in all 79 patients in the group compared with 13 of 78 patients (17%) with an insufficient lymph node evaluation in the MT group ( P = 0.0002). Conclusion This study demonstrated that Carnoy's fixation with compression can significantly increase lymph node yields in colorectal cancer specimens and allow for a higher rate of adequate lymph node sampling.