An audit of pathology lymph node dissection techniques in pylorus preserving Kausch-Whipple pancreatoduodenectomy specimens

Aims-To determine whether or not identifying recognised anatomical grouping s of lymph nodes (LNs) improves LN yield in pancreatoduodenectomy resection specimens. Methods-All the pathology reports from pancreatoduodenectomy resection spec imens between January 1997 and September 1999, for one specialist pathologi st at the Royal Liverpool University Hospital, were examined retrospectivel y. The total number of LNs found in each specimen was determined and the me thod of identifying LNs established for each case. LNs were found using eit her (1) the UICC TNM anatomical groupings, termed "grouped"; (2) the Japane se Pancreatic Society classification, termed "numbered"; or (3) neither the "grouped" nor "numbered" classification, termed "non-grouped". Results-A total of 50 reports (45 neoplastic, five chronic pancreatitis) we re studied, 11 with non-grouped LNs, 14 with grouped LNs, and 25 with numbe red LNs, including the five inflammatory cases. A median of 7.0 LNs was fou nd in non-grouped cases, a significantly lower number than in the grouped c ases (median, 12.0; Mann-Whitney U, p < 0.039) and numbered cases (median, 17.0; p < 0.0001). There was no significant difference in the LN yield betw een grouped and numbered cases (p = 0.1066). LNs were found most frequently in the inferior, posterior pancreaticoduodenal, and infrapyloric regions. Conclusions-A detailed knowledge of the anatomical distribution of LNs in p ancreatoduodenectomy resection specimens significantly improves LN yield. I t is suggested that illustrations of LN sites in resection specimens should be included in pathology guidelines/proformas to improve LN detection and, therefore, pathological prognostic data.