Evaluation of Perivesical Lymph Nodes in Radical Cystectomy Specimens for Bladder Carcinoma and Their Impact on Tumor Staging
RA Lange, SJ Hall, GQ Xiao, MT Idrees, PD Unger. Mount Sinai School of Medicine, New York, NY; Indiana University, Indianapolis, IN
Background: Lymphadenectomy has an important role in staging of bladder cancer and identifying patients who may benefit from adjuvant therapy. Approximately 20 percent of patients undergoing pelvic lymphadenectomy with radical cystectomy for bladder cancer have lymph node metastases. Previous studies have also shown that an increased number of lymph nodes retrieved from a cystectomy specimen is associated with improved overall survival for a given stage. In general, pathologic evaluation of lymph nodes in bladder cancer has come from formal pelvic lymph node dissections separate from the cystectomy specimen. To our knowledge, there have been no studies evaluating lymph nodes retrieved from the perivesical fat attached to the cystectomy specimen.
Design: A total of 33 radical cystectomies for bladder cancer from 2002 to 2008 were reviewed from our files. In all cases, formal lymph node dissections were sent separately by the surgeon, while perivesical lymph nodes were dissected from the perivesical fat by the pathologist. Thirteen cases had perivesical lymph nodes identified. These cases were reviewed for the presence of tumor metastasis to perivesical lymph nodes and were compared with the pelvic lymph node dissections sent with each specimen.
Results: Perivesical nodes were reported in 13 of 33 cases. Of these, 2 cases were pT1, 3 cases pT2, 6 cases pT3, and 2 cases pT4. The number of perivesical nodes retrieved ranged from 1 to 12, and the number of these with metastatic carcinoma ranged from 1 to 3. The size of these nodes ranged from 0.1 cm to 1.9 cm, and the size of the metastasis ranged from less than 0.1 cm to 1.9 cm (entirely replacing the node). The number of nodes in the formal lymph node dissections ranged from 1 to 20, and the number of these with metastases ranged from 0 to 3. In 6 cases, perivesical nodes were the only nodes with metastases, changing the pathologic stage from N0 to N1 in 4 cases and N0 to N2 in 2 cases. In 1 case, metastases to perivesical nodes as well as pelvic nodes changed the stage from N1 to N2.
Conclusions: In nearly half of the cases, perivesical lymph nodes were the only nodes in which metastases were identified. In more than half of cases, identification of metastases in perivesical nodes increased the pathologic stage by at least one level. These results emphasize the need for a liberal dissection of perivesical fat by the surgeon and for extensive sampling of the fat for lymph nodes by the pathologist.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 100, Tuesday Morning