Characteristics of Pelvic Lymph Node Metastases in Prostatic Adenocarcinoma

Abstract

Pelvic lymph node dissection (PLND) is currently the most accurate staging modality for lymph node metastases in prostate adenocarcinoma. There is no consensus on the optimal sampling method of PLND specimens among pathologists. This study analyzed the effectiveness of the submission of entire adipose tissue in 451 cases and its impact on total lymph node yield and detection of positive lymph nodes. The sizes of metastatic foci and positive lymph nodes in 83 cases were also studied. Submission of entire adipose tissue increased the lymph node yield and positive lymph node detection by 36.7 % and 1.99 %, respectively. Three cases had positive lymph nodes exclusively in adipose tissue. Of the patients examined, 68% had the largest positive lymph node, <1 cm. In conclusion, it was noted that metastases from prostate cancer were frequently small and seen within small lymph nodes. Submission of entire adipose tissue substantially increased the lymph node yield, but its impact on the detection of additional positive lymph nodes was low. Submission of the entire adipose tissue may be considered as an option in patients with high-risk factors for lymph node metastases.

Radical Prostatectomy Findings in White Hispanic/Latino Men With NCCN Very Low-risk Prostate Cancer Detected by Template Biopsy

“…Adipose tissue in pelvic lymph node dissection specimens was submitted in toto for histologic analysis after dissection of grossly visible lymph nodes. 13 As our study included patients over a time period when International Society of Urological Pathology (ISUP) conducted 2 modifications of PCa grading, 14–16 we re-reviewed biopsies for cases that were upgraded at RP and identified 1 case from 2004 that had occasional small cribriform glands graded as pattern 4 in current practice (Fig. 1).…”

Handling and reporting of pelvic lymphadenectomy specimens in prostate and bladder cancer: a web‐based survey by the European Network of Uropathology

“…Not surprisingly, studies have shown that total embedding can increase the nodal yield following RP and RC and may improve the detection of metastases, particularly in PCa, where there is a poor correlation between LN size and metastatic involvement . Yoon et al . and Perry‐Keene et al .…”

“…In a previous survey on PCa conducted by the International Society of Urological Pathology (ISUP), 27% of members submitted the entire PLND specimen . Not surprisingly, studies have shown that total embedding can increase the nodal yield following RP and RC and may improve the detection of metastases, particularly in PCa, where there is a poor correlation between LN size and metastatic involvement . Yoon et al .…”

Complete Tissue Submission to Increase Lymph Node Detection in Pelvic Lymph Node Packets Submitted for Patients Undergoing Radical Prostatectomy and Radical Cystectomy

“…An increase in metastatic lymph node detection and increased N-stage would warrant a change in clinical management, potentially with implementation of adjuvant therapies. Specifically, Yoon et al 13 introduced the benefit of submitting all lymph node packet adipose tissue, specifically in detecting metastatic deposits of prostate cancer. It will be important to evaluate the potential value of improved staging and prognostication provided by implementation of this new grossing technique in the setting of the increased cost incurred for paraffin blocks, slides, pathologist evaluation, reporting, and storage.…”

“…From the surgical pathology perspective, improved techniques of tissue processing have been proposed and implemented to provide a higher nodal count for evaluation based on the tissue packets removed at time of surgery. [11][12][13] In an attempt to increase the identification of lymph nodes detected in pelvic lymphadenectomy specimens, we implemented a new tissue processing protocol at our institution's surgical pathology department. We demonstrate the difference in lymph node yield in both RP and RC cases before and after implementation of this protocol at our institution, with no significant alteration in surgical lymphadenectomy template at the time of surgery.…”