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

Rais‐Bahrami, Soroush; Tracht, Jessica P.; McIntosh, Eleanor R.; Lai, Win Shun; Gordetsky, Jennifer B.

doi:10.1177/1066896916657590

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…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 .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Aims: Pathological evaluation of lymphadenectomy specimens plays a pivotal role in accurate lymph node (LN) staging. Guidelines standardising the gross handling and reporting of pelvic LN dissection (PLND) in prostate (PCa) and bladder (BCa) cancer are currently lacking. This study aimed to establish current practice patterns of PLND evaluation among pathologists. Methods and results: A web-based survey was circulated to all members of the European Network of Uropathology (ENUP), comprising 29 questions focusing on the macroscopic handling, LN enumeration and reporting of PLND in PCa and BCa. Two hundred and eighty responses were received from pathologists throughout 23 countries. Only LNs palpable at grossing were submitted by 58%, while 39% routinely embedded the entire specimen. Average LN yield from PLND was ≥10 LNs in 56% and <10 LNs in 44%.Serial section(s) and immunohistochemistry were routinely performed on LN blocks by 42% and <1% of respondents, respectively. To designate a LN microscopically, 91% required a capsule/subcapsular sinus. In pN+ cases, 72% reported the size of the largest metastatic deposit and 94% reported extranodal extension. Isolated tumour cells were interpreted as pN1 by 77%. Deposits identified in fat without associated lymphoid tissue were reported as tumour deposits (pN0) by 36% and replaced LNs (pN+) by 27%. LNs identified in periprostatic fat were included in the PLND LN count by 69%. Conclusion: This study highlights variations in practice with respect to the gross sampling and microscopic evaluation of PLND in urological malignancies. A consensus protocol may provide a framework for more consistent and standardised reporting of PLND specimens.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Formalin-fixed LN specimens were completely embedded in paraffin and processed according to the protocol described by Rais-Bahrami et al [22]. Paraffin-embedded sections of thickness 2 µm were routinely stained with haematoxylin and eosin, and where required immunohistochemical staining with a pancytokeratin antibody (AE1/3, dilution 1:100) was performed to exclude micrometastases.…”

Section: Methodsmentioning

confidence: 99%

Prospective evaluation of the performance of [68Ga]Ga-PSMA-11 PET/CT(MRI) for lymph node staging in patients undergoing superextended salvage lymph node dissection after radical prostatectomy

Abufaraj

Grubmüller

Zeitlinger

et al. 2019

Eur J Nucl Med Mol Imaging

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Purpose To assess the accuracy of [ 68 Ga]-PSMA-11 PET/CT or [ 68 Ga]-PSMA-11 PET/MRI (PSMA-11 PET/CT(MRI)) for lymph node (LN) staging using salvage LN dissection (SLND) in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). Patients and methods In a prospective study, 65 consecutive patients who developed BCR after RP underwent SLND after PSMA-11 PET/CT(MRI) between 2014 and 2018. Extended SLND up to the inferior mesenteric artery was performed in all patients. Regional and template-based correlations between the presence of LN metastases on histopathology and whole-body PSMA-11 PET/CT(MRI) results were evaluated. The diagnostic accuracy of PSMA-11 PET/CT(MRI) was also evaluated in relation to PSA level at the time of SLND. Results The median age of the patients at the time of SLND was 65 years (IQR 63–69 years) and the median PSA level was 1.4 ng/ml (IQR 0.8–2.9 ng/ml). Before SLND, 50 patients (77%) had additional therapy after RP (26.2% androgen-deprivation therapy and 50.8% radiotherapy). The median number of LNs removed on SLND was 40 (IQR 33–48) and the median number of positive nodes was 4 (IQR 2–6). LN metastases were seen in 13.8% of resected LNs (317 of 2,292). LNs positive on PSMA-11 PET/CT(MRI) had a median diameter of 7.2 mm (IQR 5.3–9 mm). Metastatic LNs in regions negative on PSMA-11 PET had a median diameter of 3.4 mm (IQR 2.1–5.4 mm). In a regional analysis, the sensitivity of PSMA-11 PET/CT(MRI) ranged from 72% to 100%, and the specificity from 96% to 100%. Region-specific positive and negative predictive values ranged from 95% to 100% and 93% to 100%, respectively. Conclusion PSMA-11 PET/CT(MRI) has a very good performance for the identification of LN metastases in patients with BCR after RP. The high diagnostic accuracy in the regional and subregional analyses demonstrates the potential of this approach to enable a region-directed instead of a complete bilateral therapeutic intervention. The performance of PSMA-11 PET/CT(MRI) is dependent on the PSA level and the size of the metastatic deposit.

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Shortwave infrared imaging increases the number of lymph nodes and the number of positive lymph nodes in surgical pathology specimens – a 104-patient study

Jorns,

Smith,

Strenk

et al. 2024

Preprint

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Aims: Adequate lymph node examination is key to accurate cancer staging. Lymph node search in surgical resection specimens is a challenging task because it can be labor intensive and inconsistent. This study investigates the effectiveness of shortwave infrared imaging technology in increasing the overall and positive lymph node numbers. Methods: 104 surgical resection specimens from two hospitals were first grossed with traditional manual palpation. The residual tissues were then grossed with the assistance of shortwave infrared imaging. The numbers of lymph nodes and positive lymph nodes within these two steps were documented and compared. Results: In 90 of the 104 cases (86.5%), shortwave infrared imaging assisted gross examination identified additional lymph nodes. In 11 of 104 cases (10.6%), shortwave infrared imaging assisted gross examination identified additional positive lymph nodes. Conclusions: Shortwave infrared imaging increases the number of lymph nodes and the number of positive lymph nodes in surgical pathology specimens compared to traditional visual and manual dissection.

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

Abstract: Submitting all additional fatty tissue after palpable identification of LNs can significantly increase the detection of LNs in RP and RC cases.

Cited by 5 publications

References 23 publications

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

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

Prospective evaluation of the performance of [68Ga]Ga-PSMA-11 PET/CT(MRI) for lymph node staging in patients undergoing superextended salvage lymph node dissection after radical prostatectomy

Shortwave infrared imaging increases the number of lymph nodes and the number of positive lymph nodes in surgical pathology specimens – a 104-patient study

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