Detection of Carcinoembryonic Antigen Messenger RNA in Lymph Nodes from Patients with Colorectal Cancer

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Abstract
The study by Liefers et al. (July 23 issue)1 demonstrated the prognostic importance of micrometastases detected by the use of a tissue-specific reverse-transcriptase–polymerase-chain-reaction assay (PCR) in patients with colorectal cancer. However, certain issues are of concern. Only 192 lymph nodes were analyzed, an average of 7 per patient. Histologic assessment of lymph nodes in stage T3 colorectal cancer by Goldstein et al. has shown the importance of the number of nodes examined per specimen.2 When 5 to 8 nodes were examined, only 31 percent of the specimens were found to have metastases, but when 17 to 20 nodes were examined, 87 percent of the specimens were found to have metastases. These findings suggest that the true incidence of micrometastases may have been underestimated, but we have found that the likelihood of detecting micrometastases in histologically negative nodes increases when metastases are present in other lymph nodes.3

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