The Hunt for Lymph Nodes: Is Total Submission of Standard-Template and Extended-Template Pelvic Lymph Node Dissections Necessary for Detecting Metastatic Prostate Cancer?

IF 3.7 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY
Mohamad Mazen Gafeer, Aileen Grace P Arriola
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引用次数: 0

Abstract

Context.—: There are no consensus guidelines on submission of pelvic lymph node dissection (PLND) specimens for radical prostatectomies. Complete submission is only performed by a minority of laboratories. Our institution has been following this practice for standard-template and extended-template PLND.

Objective.—: To investigate the utility of total submission of PLND specimens for prostate cancer and understand its impact on patients and the laboratory.

Design.—: Retrospective study examining 733 cases of radical prostatectomies with PLND performed at our institution. Reports and slides with positive lymph nodes (LNs) were reviewed. Data on LN yield, cassette usage, and impact of submission of remaining fat after dissection of grossly identifiable LNs were assessed.

Results.—: Most cases involved submission of extra cassettes for remaining fat (97.5%, n = 697 of 715). Extended PLND yielded a higher mean number of total and positive LNs versus standard PLND (P < .001). However, extended PLND required significantly more cassettes for remaining fat (mean, 8; range, 0-44). There was poor correlation between number of cassettes submitted for PLND with total and positive LN yield and between remaining fat with LN yield. Most positive LNs were grossly identified (88.5%, n = 139 of 157) and were typically larger than those not. Only 4 cases (0.6%, n = 4 of 697) would have been understaged without complete submission of PLND.

Conclusions.—: Total submission of PLND increases detection of metastasis and LN yield yet increases workload significantly with only minimal patient management impact. Hence, we recommend that meticulous gross identification and submission of all LNs be pursued without the need to submit the remaining fat of PLND.

寻找淋巴结:是否需要完全提交标准模板和扩展模板盆腔淋巴结清扫来检测转移性前列腺癌?
上下文。-:对于根治性前列腺切除术提交盆腔淋巴结清扫(PLND)标本尚无一致的指导方针。只有少数实验室完成了完整的提交。我们的机构一直遵循这一做法的标准模板和扩展模板plnd。-:研究前列腺癌PLND标本总提交的效用,并了解其对患者和实验室的影响。回顾性分析我院733例根治性前列腺切除术合并PLND的病例。我们回顾了淋巴结阳性的报告和切片。我们评估了LN产率、卡带使用情况以及解剖可识别的LN后剩余脂肪提交影响的数据。-:大多数病例涉及提交额外的磁带以保存剩余脂肪(97.5%,n = 697 / 715)。与标准PLND相比,扩展PLND产生了更高的平均总LNs数和阳性LNs数(P < 0.001)。然而,延长PLND需要更多的卡带来储存剩余脂肪(平均值,8;范围,0-44)。提交PLND的盒式磁带数量与总LN产量和阳性LN产量之间的相关性较差,剩余脂肪与LN产量之间的相关性较差。大多数阳性LNs被粗略识别(88.5%,n = 139 / 157),并且通常大于非阳性LNs。只有4例(0.6%,697例中n = 4例)在没有完整提交plnd的情况下未完成手术。-: PLND的总提交增加了转移的检出率和淋巴结转移率,但显著增加了工作量,对患者管理的影响很小。因此,我们建议在不需要提交规划纲要的剩余部分的情况下,对所有的规划纲要进行细致的总体鉴定和提交。
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来源期刊
CiteScore
9.20
自引率
2.20%
发文量
369
审稿时长
3-8 weeks
期刊介绍: Welcome to the website of the Archives of Pathology & Laboratory Medicine (APLM). This monthly, peer-reviewed journal of the College of American Pathologists offers global reach and highest measured readership among pathology journals. Published since 1926, ARCHIVES was voted in 2009 the only pathology journal among the top 100 most influential journals of the past 100 years by the BioMedical and Life Sciences Division of the Special Libraries Association. Online access to the full-text and PDF files of APLM articles is free.
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