Three-dimensional computer-assisted dissection of pancreatic lymphatic anatomy on human fetuses: a step toward automatic image alignment

• Published in: Surgical and radiologic anatomy (English ed.) Vol. 40; no. 5; pp. 587 - 597
• Main Authors: Bardol, T., Subsol, G., Perez, M.-J., Genevieve, D., Lamouroux, A., Antoine, B., Captier, G., Prudhomme, M., Bertrand, M. M.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.05.2018; Springer Nature B.V; Springer Verlag (Germany)
• Subjects: Anatomy; Aorta; Computer Science; Dissection - methods; Fetus - anatomy & histology; Fetuses; Graphics; Humans; Imaging; Lymph nodes; Lymphatic Metastasis; Lymphatic system; Lymphatic System - anatomy & histology; Lymphatic System - pathology; Male; Medicine; Medicine & Public Health; Original Article; Orthopedics; Pancreas - anatomy & histology; Pancreatic cancer; Pancreatic Neoplasms - pathology; Radiology; Spleen; Surgery; Vascularization; Lymph node involvement; Lymphatic anatomy; Automatic image alignment; Pancreatic cancer; CAAD
• ISSN: 0930-1038; 1279-8517
• DOI: 10.1007/s00276-018-2008-2

Purpose Pancreatic cancer is the fourth cause of death by cancer worldwide. Lymph node (LN) involvement is known to be the main prognostic factor. However, lymphatic anatomy is complex and only partially characterized. The aim of the study was to study the pancreatic lymphatic system using computer-assisted anatomic dissection (CAAD) technique and also to update CAAD technique by automatizing slice alignment. Methods We dissected three human fetuses aged from 18 to 34 WA. 5-µm serial sections of duodeno-pancreas and spleen blocks were stained (hematoxylin–eosin, hematoxylin of Mayer and Masson trichrome), scanned, aligned and modeled in three dimensions. Results We observed a rich, diffuse but not systematized lymphatic network in the peri-pancreatic region. There was an equal distribution of LNs between the cephalic and body–tail portions. The lymphatic vascularization appeared in continuity from the celiac trunk to the distal ends of its hepatic and splenic arterial branches parallel to the nerve ramifications of the celiac plexus. We also observed a continuity between the drainage of the pancreatic head and the para-aortic region posteriorly. Conclusion In view of the wealth of peri-pancreatic LNs, the number of LNs to harvest could be increased to improve nodal staging and prognostic evaluation. Pancreatic anatomy as described does not seem to be compatible with the sentinel LN procedure in pancreatic surgery. Finally, we are now able to offer an alternative to manual alignment with a semi-automated alignment.