"Transparency" in Reporting of Radical Prostatectomy Specimens. A Simple Technique for Whole Mount Topographical Mapping of Tumor Burden Using Conventional Histologic Sections
Ralph Sams, Andres Matoso, Nick Shillingford, Sonja Chen, Diana Treaba, Evgeny Yakirevich, Ronald A DeLellis, Murray Resnick, Shamlal Mangray. Rhode Island Hospital & Alpert Medical School of Brown University, Providence, RI
Background: Prostate topographic mapping has been shown to have prognostic value in determining laterality of lymph node metastases in prostate carcinoma and provides useful information on cancer burden to the clinician. Utilization of this analysis is currently restricted to large centers that have availability of whole mount histology technique. This prevents widespread adaptation and limits the capacity for cross intitutional studies. We report a simple technique that is an alternative to whole mount histologic sections.
Design: On receipt, prostatectomy specimens are inked in 3 colors to denote right anterior, left anterior and posterior respectively inorder to facilitate orientation on examination of histologic sections. The specimens are transversely sectioned in 4-6 mm increments and slices photographed (Fig. A). After formalin fixation slices are submitted in halves or quarters and mapped on the photograph (Fig. A & Fig. B). Areas of carcinoma are outlined by a marking pen on each slide on review of histologic sections. Whole mount maps are obtained by tracing each prostatic section onto a plastic transparency (Fig. B) by correlating sections with the map from the photograph. Cancer burden is determined by overlaying the acquired whole mount transparency map onto a 1 or 2 mm grid (Fig. C) or by digital image analysis.
Results: The results obtained using this technique are demonstrated in the figure below.
Conclusions: This alternative to whole mount histologic sections lends itself to application in any anatomic pathology laboratory and will facilitate large cross intitutional studies. These transparency maps can be overlayed onto the original photograph and incorporated into the final pathology report (Fig. D). Annotation of Gleason grade can be included as well delineation of involved margins and span of involvement. Furthermore, this method has the potential for three dimensional reconstruction similar to that done in CT imaging which can also be incorporated into the final report.
Monday, March 19, 2012 1:00 PM
Poster Session II # 303, Monday Afternoon