Methylene Blue-Assisted Lymph Node Dissection in Colon Specimens : A Prospective, Randomized Study

• Published in: American journal of clinical pathology Vol. 130; no. 6; pp. 913 - 919
• Main Authors: MÄRKL, Bruno, KERWEL, Therese G, JDHNIG, Hendrik G, ORUZIO, Daniel, ARNHOLDT, Hans M, SCHÖLER, Claus, ANTHUBER, Matthias, SPATZ, Hanno
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Society of Clinical Pathologists 01-12-2008
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Colon - pathology; Colon - surgery; Female; Gastroenterology. Liver. Pancreas. Abdomen; Histocytochemistry - methods; Humans; Injections, Intra-Arterial; Investigative techniques, diagnostic techniques (general aspects); Lymph Node Excision - methods; Male; Medical sciences; Mesenteric Artery, Inferior; Methylene Blue; Middle Aged; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Prospective Studies; Rectum - pathology; Rectum - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Lymph node staging; Lymph node; Digestive system; Staging; Lymph node clearance; Stage classification; Gut; Malignant tumor; Clearance; Fat clearance; Methylene blue; Colonic disease; Prospective; Lymphadenectomy; Anatomic pathology; Randomization; Colon cancer; Fat; Digestive diseases; Intestinal disease; Colon; Cancer
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1309/AJCPVAPB5APABJNX

Recently, we introduced ex vivo intra-arterial methylene blue injection into the inferior mesenteric artery as a novel method to improve lymph node (LN) harvest in rectal cancer. We have now adapted this method to the other segments of the colon. A total of 60 cases were enrolled. Primary LN dissection was followed by fat clearance and a secondary dissection. The mean +/- SD primary LN harvest differed highly significantly with 35 +/- 18 and 17 +/- 10 LNs in the methylene blue-stained and unstained groups, respectively. Primary insufficient LN harvest occurred in 8 cases of the unstained group and in only 1 case of the methylene blue-stained group (P = .0226). After secondary dissection, upstaging was seen exclusively in the unstained group. The time/LN ratio differed significantly with 0.9 and 0.6 min/LN in the unstained and methylene blue-stained groups, respectively. Intraarterial methylene blue injection is recommended as a routine technique in the histopathologic study of colon cancer.