[Histonet] RE: Davidson's fixative

From:"Marshall Terry Dr, Consultant Histopathologist"

Sorry this is rather off-topic in as much as it is medical.
I am bothered by the reliance on rather "fussy" results to determine therapy.
In the case of LN metastases, we can surely improve the yield of positives by greater effort, time, money and vigour in the search.
However, it is a practical impossibility to be exhaustive in our examination of nodes.
Do we get a better yield by finding a 2mm node than by cutting multiple blocks of a 8mm node? What about levels? How about immunochemistry?
We are now being told that there is an entity of micrometastases, that is to say, nodal metastases that are "isolated" and less than 2mm diameter. These, we are told, are to be disregarded. Logically, if we see one, we should cut levels to see if they expand to more than 2mm.
I find this all to be utter garbage, and I don't mean (just) my post:-)

Dr Terry L Marshall, B.A.(Law), M.B.,Ch.B.,F.R.C.Path
 Consultant Pathologist
 Rotherham General Hospital
 South Yorkshire

-----Original Message-----
From: RSRICHMOND@aol.com [mailto:RSRICHMOND@aol.com]
Sent: 02 July 2004 15:10
To: Marshall Terry Dr, Consultant Histopathologist; histonet@lists.utsouthwestern.edu
Subject: Re: Davidson's fixative

Dr Terry L Marshall, Consultant Pathologist, Rotherham General Hospital, South Yorkshire, England replies to my comment about the usefulness of clearing fixatives in staging colon cancer:

>>"In colon cancer positive lymph nodes are sometimes very small, and finding even one positive lymph node often results in a patient's receiving postoperative chemotherapy and maybe having their life saved by it." Do you really, really believe that Bob?<<

I'm not sure that this is an evidence-based statement, but the chemotherapy of colon cancer is beginning to make some real advances after a very long period of stagnation, and I feel like going along with what the oncologists are asking for. - Anyway, I did say "maybe".

Bob Richmond
Samurai Pathologist
Knoxville TN and Gastonia NC 

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