title: Histopathological assessment of lymph nodes in upper gastrointestinal cancer: does triple levelling detect significantly more metastases?
abstract: BACKGROUND
  For cancers of the upper gastrointestinal tract it is standard to examine one section/level, from paraffin blocks containing lymph node tissue, for metastatic tumour.
  
  
  OBJECTIVE
  To determine whether significantly more metastases can be detected by assessing two additional levels.
  
  
  METHODS
  101 archival upper gastrointestinal cancers were evaluated. All negative lymph nodes were examined at two additional levels separated by 100 microm and stained by H&E. The slides were examined for the presence of metastases.
  
  
  RESULTS
  1143 lymph nodes, that were originally clear of metastases, were examined at a further two levels (three levels in total); 23 additional metastases were identified in 17 patients. Eleven of these patients were already stage N1 before examination of the additional levels. However, six patients were originally N0, and were therefore upgraded to N1.
  
  
  CONCLUSIONS
  Examining lymph nodes at three levels did detect more metastatic deposits than examination of one section/level. In six patients this changed the N stage from N0 to N1. This would have significant prognostic and management implications.
authors.affiliation: Department of Histopathology, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: McGrath
authors.forename: Sarah
authors.initials: S
authors.lastname: Cross
authors.forename: Susan Anne
authors.initials: SA
authors.lastname: Pritchard
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery; D002454:Cell Differentiation; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005188:False Negative Reactions; D005743:Gastrectomy; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery