Anterior Fat Pad Lymph Node Evaluation in Robot-Assisted Radical Prostatectomy (RARP) Specimens.
Sung Hee Kang, Hee Sang Hwang, Su Hyun Yoo, Dal San Yoo, Hanjong Ahn, Yong Mee Cho, Elizabeth McQuitty, Jae Yoon Ro. University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; The Methodist Hospital, Weill Medical College of Cornell University, Houston, TX
Background: Urologists dissect the anterior fat pad (AFP) during RARP because this facilitates visualization of the prostate apex and bladder neck. AFP evaluation may be essential procedure during RARP, because lymph nodes in AFP may harbor metastatic tumor. Then, not only pelvic lymph node metastasis, but also the metastatic status of AFP lymph nodes, can be a prognostic factor and influence tumor stage grouping.
Design: 439 patients underwent RARP at the Asan Medical Center from July, 2007 to August, 2010. Of these, 221 included AFP excision. We reviewed the final reports and H&E slides to assess presence and number of lymph nodes in the AFP, as well as rates of metastasis to these lymph nodes.
Results: Among the 221 cases with AFP dissection, 18 (8.1 %) had one each AFP lymph node and 203 (91.9 %) had no lymphoid tissue in the AFP. Two of the 18 cases with AFP lymph nodes had metastatic carcinoma in a completely effaced node. All 18 cases with AFP lymph nodes had pelvic lymph node dissection, and 1 of the cases with AFP nodal metastasis also had pelvic lymph node metastasis. The case with metastatic carcinoma in AFP and pelvic lymph nodes had a preoperative PSA of 48.8 ng/ml, and a Gleason score 7 (4+3); in the case with metastatic AFP lymph node but negative pelvic lymph nodes, these values were 34 ng/ml and 9 (4+5), respectively
Conclusions: In our study, AFP lymph nodes were found in 18 of 221 RARP specimens with AFP dissection (8.1 %), with metastatic carcinoma in 2 of these 18 cases. One case also had pelvic lymph node metastasis, but the other was negative for pelvic lymph node metastasis. In this case, tumor stage grouping would be falsely low in the absence of AFP lymph node evaluation. Since AFP excision is regarded as routine during RARP, a careful evaluation for the presence of lymph node (s) in the AFP specimens is recommended because lymph node status in AFP may have a significant impact on tumor stage.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:00 PM
Poster Session II # 130, Monday Afternoon