Can GEWF solution improve the retrieval of lymph nodes from colorectal cancer resections?

Arch Pathol Lab Med. 2009 Jan;133(1):83-6. doi: 10.5858/133.1.83.


Context: Lymph node status is an important prognostic factor in colorectal cancer staging.

Objective: To determine whether the use of GEWF solution (glacial acetic acid, ethanol, distilled water, formaldehyde) increases the yield of lymph nodes (LNs) from colorectal cancer specimens.

Design: A prospective study investigated the usefulness of GEWF in identifying LN from colorectal cancer resection specimens. After standard formalin fixation, approximately half of the specimens were placed in GEWF solution, and the remainder were used as a control. The number of LNs, patient sex, length of specimen, site of the specimen, tumor staging, and the number of positive LNs were analyzed. The numbers of retrieved and metastasis-positive LNs were recorded and compared with specimens from the previous year, in which no GEWF solution was used. Residents were educated on the importance of LN status before the study. Data were analyzed using independent-sample t tests. The residents also completed a subjective survey at the conclusion of the study.

Results: A total of 85 specimens, 45 (53%) with GEWF and 40 (47%) without GEWF, were examined by 11 residents. The mean number of retrieved LNs using GEWF was slightly higher than the control group (19.96 vs 18.30); however, there was no statistical significance (P = .53). The mean number of LNs from the current study (2004- 2005) is significantly higher than that from the previous year (2003-2004) (19.17 vs 11.51, P < .001).

Conclusions: GEWF did not increase the yield of LNs from colorectal cancer specimens. However, application of the guideline for a minimum of 12 LNs significantly increased the LN retrieval.

MeSH terms

  • Acetic Acid / chemistry
  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / secondary
  • Adenocarcinoma / surgery*
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / surgery*
  • Ethanol / chemistry
  • Female
  • Formaldehyde / chemistry
  • Humans
  • Lymph Node Excision / methods*
  • Lymph Nodes / pathology*
  • Male
  • Prognosis
  • Prospective Studies
  • Sample Size
  • Tissue Fixation / methods*
  • Water / chemistry


  • Water
  • Formaldehyde
  • Ethanol
  • Acetic Acid