Total Submission of Pelvic Lymphadenectomies Performed at Radical Prostatectomy Increases Lymph Node Yields and Detection of Microscopic Metastases.
Joanna L Perry-Keene, Hemamali Samaratunga, Vipul Vyas, Brett Delahunt. Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Aquesta Pathology, Brisbane, QLD, Australia; Wellington School of Medicine and Health Science, University of Otago, Wellington, New Zealand
Background: Lymph node metastasis in prostate cancer is associated with poor prognosis, being indicative of stage 4 disease. Studies indicate up to a median of 16 lymph nodes are identified in pelvic lymphadenectomies, while a minimum of 13 nodes is required to accurately identify lymph node metastases. The 2009 ISUP consensus conference found less than 10% of respondents detected more than 10 lymph nodes per case, although only 41% blocked the entire specimen, including fat. Currently there is no consensus as to the optimal handling of lymphadenectomy specimens received with radical prostatectomies.
Design: 110 consecutive radical prostatectomies with pelvic lymph node sampling were examined. All tissue from the lymphadenectomies was submitted with macroscopically palpable lymph nodes blocked separately. The following parameters were recorded: number of macroscopically identified palpable lymph nodes, number of microscopically identified impalpable lymph nodes, number of blocks submitted, number of nodes involved by metastatic adenocarcinoma, size of metastasis and whether the involved node was palpable or impalpable.
Results: As shown in figure 1, submission of all tissue from pelvic lymphadenectomy specimens increased the lymph node yield from an average of 3.75 to 10.8 lymph nodes. Metastatic prostate cancer was identified in 8 of 110 cases (7.3%). 5 (63%) of the metastases were identified in palpable lymph nodes alone. In two cases, metastases were identified in both palpable and impalpable lymph nodes. In one case, the metastasis was identified in an impalpable lymph node only.
Conclusions: Submission of all tissue from pelvic lymphadenectomies markedly improved lymph node yields and facilitated identification of macroscopically undetectable lymph nodes, some of which were demonstrated to contain metastases. We conclude that submission of the complete lymphadectomy specimen improves staging accuracy and prognostication.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:00 PM
Poster Session II # 126, Monday Afternoon