Optimal sampling of pelvic lymphadenectomy specimens following radical prostatectomy: is complete tissue submission justified?

Mhaolcatha, Sarah Ní; Power, E; Mayer, Nick; Prendeville, Susan

doi:10.1136/jclinpath-2019-205839

Cited by 5 publications

(3 citation statements)

References 17 publications

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“…It is also possible that more extended dissections were performed in high‐risk cases, or when suspicious nodes were found intra‐operatively. Finally, it should be remembered that there is no consensus for the identification, analysis and count of lymph nodes on pathological examination [20]. In line with data in the literature, haemorrhagic and infective complications were quite low, with overall rates of 2.7% and 3.6%, respectively.…”

Section: Discussionmentioning

confidence: 79%

Indications for and complications of pelvic lymph node dissection in prostate cancer: accuracy of available nomograms for the prediction of lymph node invasion

et al. 2020

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Objectives To externally validate the currently available nomograms for predicting lymph node invasion (LNI) in patients with prostate cancer (PCa) and to assess the potential risk of complications of extended pelvic lymph node dissection (ePLND) when using the recommended threshold. Methods A total of 14 921 patients, who underwent radical prostatectomy with ePLND at eight European tertiary referral centres, were retrospectively identified. After exclusion of patients with incomplete biopsy or pathological data, 12 009 were included. Of these, 609 had undergone multiparametic magnetic resonance imaging‐targeted biopsies. Among ePLND‐related complications we included lymphocele, lymphoedema, haemorrhage, infection and sepsis. The performances of the Memorial Sloan Kettering Cancer Centre (MSKCC), Briganti 2012, Briganti 2017, Briganti 2019, Partin 2016 and Yale models were evaluated using receiver‐operating characteristic curve analysis (area under the curve [AUC]), calibration plots, and decision‐curve analysis. Results Overall, 1158 patients (9.6%) had LNI, with a mean of 17.7 and 3.2 resected and positive nodes, respectively. No significant differences in AUCs were observed between the MSKCC (0.79), Briganti 2012 (0.79), Partin 2016 (0.78), Yale (0.80), Briganti 2017 (0.81) and Briganti 2019 (0.76) models. A direct comparison of older models showed that better discrimination was achieved with the MSKCC and Briganti 2012 nomograms. A tendency for underestimation was seen for all the older models, whereas the Briganti 2017 and 2019 nomograms tended to overestimate LNI risk. Decision‐curve analysis showed a net benefit for all models, with a lower net benefit for the Partin 2016 and Briganti 2019 models. ePLND‐related complications were experienced by 1027 patients (8.9%), and 12.6% of patients with pN1 disease. Conclusions The currently available nomograms have similar performances and limitations in the prediction of LNI. Miscalibration was present, however, for all nomograms showing a net benefit. In patients with only systematic biopsy, the MSKCC and Briganti 2012 nomograms were superior in the prediction of LNI.

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Section: Discussionmentioning

confidence: 79%

Indications for and complications of pelvic lymph node dissection in prostate cancer: accuracy of available nomograms for the prediction of lymph node invasion

et al. 2020

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“…This issue has also been discussed for other neoplasia. Although in some studies, micrometastases were detected in 1%-3% of LN when the remaining fat tissue was embedded after palpation [12,13], these findings have a low prognostic impact [14]. Moreover, even if more LN are found when a complete embedding of the remaining tissue is performed, most of them are negative or were already positive at palpation [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Is the pN category in radical cystectomy dependent on the pathologist dissection?

Algaba¹

2021

Cancer Rep Rev

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A correlation exists between the number of lymph nodes (LNs) detected in radical cystectomy specimens and the accuracy of pathologic nodal (pN) staging. In this context, correct handling of pathology specimens is crucial, but there is currently no consensus on the optimal methodology. The objective of the present study was to compare two main methods: palpation and complete embedding of all fat tissue. Palpation of LNs and complete embedding of remaining fat tissue were performed in 42 patients. In 33.3% of the patients, no LNs were observed in the remaining fat tissue. The mean number and size of LNs detected were, respectively, 14 and 9 mm with palpation and 2.9 and 5 mm with complete embedding of remaining fat tissue. All positive LNs (30.9%) were detected by palpation. The mean pN density was 12.9% with palpation and 10.7% with complete embedding. All patients with a LN density higher than 20% were already observed by manual palpation.In conclusion, the complete embedding of fat tissue does not have a crucial impact on evaluation of the pN category.

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“…Mhaolcatha et al in their study of radical prostatectomy specimens, where a 70% increase in median nodal count was seen. 19 Other techniques, such as methylene blue and fat dissolution, have demonstrated similar positive effects in a meta-analysis by Abbassi-Ghadi et al 7 Amongst the 10 units in the top tertile for achieving the NOGCA nodal count threshold, four used systematic fat blocking (compared to none in the lowest tertile), and five of the remaining six routinely reexamined specimens and blocked remaining fat if threshold count values were not met (compared to four of ten in the lowest tertile). This variation in practice has clear implications for the interpretation of nodal counts as a quality marker at a national level, and must be taken into consideration.…”

Section: Discussionmentioning

confidence: 99%

Variation in histopathological assessment and association with surgical quality indicators following oesophagectomy

Pucher

Green

Bateman

et al. 2020

British Journal of Surgery

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Background Histopathological outcomes, such as lymph node yield and margin positivity, are used to benchmark and assess surgical centre quality, and are reported annually by the National Oesophago-Gastric Cancer Audit (NOGCA) in England and Wales. The variation in pathological specimen assessment and how this affects these outcomes is not known. Methods A survey of practice was circulated to all tertiary oesophagogastric cancer centres across England and Wales. Questions captured demographic data, and information on how specimens were prepared and analysed. National performance data were retrieved from the NOGCA. Survey results were compared for tertiles of lymph node yield, and circumferential and longitudinal margins. Results Survey responses were received from 32 of 37 units (86 per cent response rate), accounting for 93.1 per cent of the total oesophagectomy volume in England and Wales. Only 5 of 32 units met or exceeded current guidelines on specimen preparation according to the Royal College of Pathologists guidelines. There was wide variation in how centres defined positive (R1) margins, and how margins and lymph nodes were assessed. Centres with the highest nodal yield were more likely to use systematic fat blocking, and to re-examine specimens when the initial load was low. Systematic blocking of lesser curve fat resulted in significantly higher rates of patients with at least 15 lymph nodes examined (91.4 versus 86.5 per cent; P = 0.027). Conclusion Preparation and histopathological assessment of specimens varies significantly across institutions. This challenges the validity of currently used surgical quality metrics for oesophageal and other tumours.

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Optimal sampling of pelvic lymphadenectomy specimens following radical prostatectomy: is complete tissue submission justified?

Cited by 5 publications

References 17 publications

Indications for and complications of pelvic lymph node dissection in prostate cancer: accuracy of available nomograms for the prediction of lymph node invasion

Indications for and complications of pelvic lymph node dissection in prostate cancer: accuracy of available nomograms for the prediction of lymph node invasion

Is the pN category in radical cystectomy dependent on the pathologist dissection?

Variation in histopathological assessment and association with surgical quality indicators following oesophagectomy

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