Lymph node staging in prostate cancer: perspective for the pathologist

Prendeville, Susan; Kwast, Theodorus H. van der

doi:10.1136/jclinpath-2016-203643

Cited by 16 publications

(17 citation statements)

References 82 publications

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“…Various minimal nodal yields have been proposed as a quality indicator for accurate LN staging following PLND; however, heterogeneity of studies in terms of surgical extent and pathological techniques make it difficult to define an appropriate threshold . In PCa, nodal counts ranging from 10 to >20 have been suggested, although a previous ISUP survey found that such nodal yields were not common in routine practice .…”

Section: Discussionmentioning

confidence: 99%

“…The pathological assessment of PLND specimens plays a critical role in the evaluation of regional LNs. In addition to accurate nodal staging, other parameters, including LN density, metastatic tumour size and extranodal spread, may also have prognostic significance in patients with metastatic disease . Variations in pathology practice and methods of LN counting are known to influence LN yield, yet this parameter is often used as a surrogate marker for the adequacy and extent of surgical dissection both in clinical practice and the published literature.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…For this reason, any differences in the dissection area and methods were negligible. There are no established guidelines regarding the optimum method of examining PLND specimens, and the approach may vary considerably between individual pathologists and institutions (20). At our institution, PLND specimens were processed using the same methods as the RP specimens.…”

Section: Standardmentioning

confidence: 99%

Eliminating microscopic lymph node metastasis by performing pelvic lymph node dissection during radical prostatectomy for prostate cancer

et al. 2019

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The oncological benefit of pelvic lymph node dissection (PLND) for prostate cancer (PCa) remains unclear. The therapeutic effect of PLND on the elimination of microscopic metastases during radical prostatectomy (RP) for PCa was examined in the current study. A total of 348 Japanese patients with high-or intermediate-risk PCa without lymph node metastasis, who underwent antegrade RP at the Kyushu Cancer Center (Fukuoka, Japan) between August 1998 and May 2013 were retrospectively analyzed. The patients were divided into the standard (obturator + internal iliac nodes) group and the expanded (standard + additional nodes) group according to the extent of PLND. Preoperative and postoperative characteristics were also analyzed to determine the factors associated with prostate-specific antigen (PSA) failure. Standard and expanded PLND were performed in 70.9% (247/348) and 29.1% (101/348) of cases, respectively. The results revealed that preoperative PSA levels were the only marked difference between the two groups. No differences were observed in the other preoperative and postoperative characteristics. Furthermore, the rate of PSA recurrence in each group did not differ to a statistically significant extent (P=0.3622). Reducing the area of dissection from expanded PLND to standard PLND significantly reduced the number of dissected lymph nodes (P<0.0001). Additionally, the PSA level, clinical tumor stage, Gleason score of the biopsy specimen, pathological tumor stage and extent of PLND were all associated with PSA recurrence, as determined via multivariate Cox hazards regression analysis (P= 0.0177, P= 0.0023, P= 0.0027, P<0.0001 and P= 0.0164, respectively). In high-and intermediate-risk patients without lymph node metastasis, a greater number of lymph nodes were dissected when the extent of dissection was greater. Furthermore, the extent of PLND was a significantly associated with PSA failure. The results indicated that PLND exerted a therapeutic effect by eliminating microscopic pelvic lymph node metastases that were not detected by routine pathological examinations.

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“…Méndez et al (2011) identified five genes (Receptor accessory protein (1REEP1), Ring finger protein 145 (RNF145), CTONG2002744, Myosin VA (MYO5A), and FBXO32) that were differentially expressed between node-positive and node-negative oral squamous cell carcinomas (OSCC), and suggested that this model is applicable for identification of occult metastasis in patients [ 46 ]. Similarly, studies on primary lung adenocarcinomas, pancreatic, breast, bladder, and prostate cancers models depicted a marked alteration in gene expression patterns along with a high relative risk of nodal involvement [ 47 , 48 , 49 , 50 , 51 ]. 4.…”

Section: Gene Expression Profilingmentioning

confidence: 99%

The Application of Gene Expression Profiling in Predictions of Occult Lymph Node Metastasis in Colorectal Cancer Patients

et al. 2018

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A key factor in determining the likely outcome for a patient with colorectal cancer is whether or not the tumour has metastasised to the lymph nodes—information which is also important in assessing any possibilities of lymph node resection so as to improve survival. In this review we perform a wide-range assessment of literature relating to recent developments in gene expression profiling (GEP) of the primary tumour, to determine their utility in assessing node status. A set of characteristic genes seems to be involved in the prediction of lymph node metastasis (LNM) in colorectal patients. Hence, GEP is applicable in personalised/individualised/tailored therapies and provides insights into developing novel therapeutic targets. Not only is GEP useful in prediction of LNM, but it also allows classification based on differences such as sample size, target gene expression, and examination method.

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Lymph node staging in prostate cancer: perspective for the pathologist

Cited by 16 publications

References 82 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

Eliminating microscopic lymph node metastasis by performing pelvic lymph node dissection during radical prostatectomy for prostate cancer

The Application of Gene Expression Profiling in Predictions of Occult Lymph Node Metastasis in Colorectal Cancer Patients

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