Bladder Carcinoma Lymphadenectomy: How Extensive Should Nodal Dissection Be for Adequate Staging?
Mudaliar Kumaran, Wang Lu, Mehta Vikas, Barkan Guliz, Picken Maria. Loyola University Medical Center, Maywood, IL
Background: Guidelines detailing lymphadenectomy in the management of bladder carcinoma are not well-delineated and the adequacy of pathologic nodal staging is an open issue. Our aim was to evaluate the lymph node (LN) status in bladder cystectomy specimens and to assess for patterns of LN drainage.
Design: We retrospectively reviewed 249 cystectomies in correlation with the gross descriptions and evaluated for number of grossly identified versus microscopically identified LNs. The LNs were grouped into 3 categories: primary drainage ("regional nodes"), secondary drainage sites ("common iliac LNs"), and extra-regional nodes according to the 7th edition of the cancer staging manual. The cases with positive LNs were evaluated for location of positive nodes and evaluated for cases demonstating positive metastases to secondary and/or extra-regional nodes without evidence of metastasis to primary regional LNs.
Results: In all, 8,376 LNs were recovered. Of these LNs, 4,690 were grossly identified and 2,814 LNs were microscopically identified. In all, 62 cases had positive LNs with 1,100 total LNs. Of these lymph nodes, 189/805 (23.5%) primary drainage nodes were positive, 57/171 (33.3%) secondary drainage nodes were positve, and 32/123 (26%) extra-regional nodes were positive. In 6/62 (9.6%) positive cases, positive lymph nodes were identified in a secondary drainage and/or extra-regional location, but not in a primary drainage location.
Conclusions: In our study close to 10% of patients with positive LN, had skip metastases to secondary drainage regional and/or extra-regional LNs. This indicates that alternative drainage pathways that bypass the primary drainage nodes are not uncommon. Hence adequate clinical assessment of secondary regional and extra-regional drainage sites should be performed before determining the actual extent of lymphadenopathy.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 138, Monday Morning