The clinical significance of lymph node size in colon cancer

Mod Pathol. 2012 Oct;25(10):1413-22. doi: 10.1038/modpathol.2012.92. Epub 2012 Jun 8.


To date, the clinical value of lymph node size in colon cancer has been investigated only in a few studies. Only in radiological diagnosis is lymph node size routinely recognized, and nodes ≥10 mm in diameter are considered pathologic. However, the few studies regarding this topic suggest that lymph node size is not a reliable indicator of metastatic disease. Moreover, we hypothesized that increasing lymph node size is associated with favorable outcome. By performing a morphometric study, we investigated the clinical significance of lymph node size in colon cancer in terms of metastatic disease and prognosis. A cohort of 237 cases with excellent lymph node harvest (mean lymph node count: 33±17) was used. The size distribution in node-positive and -negative cases was almost identical. In all, 151 out of the 305 metastases detected (49.5%) were found in lymph nodes with diameters ≤5 mm. Only 25% of lymph nodes >10 mm showed metastases. Minute lymph nodes ≤1 mm were involved only very rarely (2 of 81 cases). In 67% of the cases, the largest positive lymph node was <10 mm. The prognostic relevance of lymph node size was investigated in a subset of 115 stage I/II cases. The occurrence of ≥7 lymph nodes that were >5 mm in diameter was significantly associated with better overall survival. Our data show that lymph node size is not a suitable factor for preoperative lymph node staging. Minute lymph nodes have virtually no role in correct histopathological lymph node staging. Finally, large lymph nodes in stage I/II disease might indicate a favorable outcome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / secondary*
  • Adenocarcinoma / surgery
  • Aged
  • Cohort Studies
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / pathology*
  • Colonic Neoplasms / surgery
  • Female
  • Germany / epidemiology
  • Humans
  • Lymph Node Excision
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Neoplasm Staging
  • Predictive Value of Tests
  • Prognosis
  • ROC Curve
  • Sentinel Lymph Node Biopsy
  • Survival Rate