Whole Mount Evaluation of Penectomies for Penile Cancer: Feasibility, Cost, and Comparison to Routine Sectioning
Joshua J Ebel, Debra L Zynger. Ohio State University Medical Center, Columbus, OH
Background: The treatment of penile cancer varies widely based on tumor extent and histologic grade. Pathologic staging may be difficult due to the complexity of penile anatomy and may additionally be challenging due to the low volume of penectomies at most institutions. Whole mount processing has been described as a useful technique for the prostate but has not been reported for penectomy. A large slide format may aid visualization and therefore staging accuracy. Our study aimed to assess whether whole mount processing is feasible for penectomy specimens and determine its effects on cost, turnaround time, and staging accuracy as compared to routine processing.
Design: A retrospective search was performed to identify pathology reports from patients who had partial or total penectomies at our institution from 2006-2012. Penectomies were routinely processed from 2006-2009 and whole mounted from 2010-2012. A genitourinary pathologist reviewed all slides, noting any discrepancies in diagnosis. Number of slides, recuts, additional blocks grossed, turnaround time, and cost were evaluated for routine and whole mount specimens.
Results: 51 penectomy specimens were identified including 30 routinely processed and 21 whole mounted. Routine cases used a mean of 10 slides per case with 7% of specimens totally embedded. Whole mount cases used a mean of 7 slides per case with 29% totally embedded. 13% of routinely sectioned cases required recuts. No whole mount cases required recuts. 20% of routine cases had additional blocks grossed with a mean of 4 blocks per case, while only 5% of whole mount cases had additional blocks grossed. Histologic processing time for routine cases was 8 hours compared to 22 hours for whole mount, reflected in the routine case mean pathology report turnaround time of 4 days compared to whole mount case mean turnaround time of 5 days. 4 discrepancies which impacted pT were identified, all in routine samples, representing 13% of this group. Changes included downstaging (pT2 to pT1a, n=1; pT3 to pT2, n=2) and upstaging (pT2 to pT3, n=1). Estimated additional cost for each whole mount case compared to routine processing was $26. As we receive 7 penectomy specimens per year, resulting in an increased yearly cost of $191.
Conclusions: Based on our experience, whole mounting is a feasible technique for penectomy that can be utilized with minimal increased cost and turnaround time and may improve staging. Institutions in which whole mounting is already established for other organs, such as prostate, may wish to consider utilizing this format for penectomy specimens.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 214, Tuesday Afternoon