Seeking a standard for adequate pathologic lymph node staging in primary bladder carcinoma.
Lu Wang1, Kumaran Mudaliar, Vikas Mehta
1Department of Pathology and Laboratory Medicine, Loyola University Medical Center, 2160 S 1st Ave, Chicago, IL, 60153, USA.
Virchows Archiv : an International Journal of Pathology
|April 5, 2014
Summary
This study evaluated lymph node (LN) staging in bladder cancer surgery, finding that examining 27 LNs, including specific drainage areas, improves accuracy for urothelial carcinoma patients. Optimal staging requires careful analysis of primary, secondary, and distant lymph nodes.
Area of Science:
- Urology
- Pathology
- Oncology
Background:
- Accurate lymph node (LN) staging is crucial for determining prognosis and treatment in urothelial carcinoma of the bladder.
- Radical cystectomy specimens offer a key opportunity for comprehensive pathologic LN assessment.
Purpose of the Study:
- To evaluate the adequacy of current lymph node (LN) staging in radical cystectomy specimens for bladder cancer.
- To analyze the frequency and anatomic distribution of lymph node (LN) metastases in urothelial carcinoma.
Main Methods:
- Retrospective review of 248 radical cystectomies for primary urothelial bladder cancer (January 2007-September 2012).
- Detailed analysis of total LNs examined, number and location of positive LNs, extranodal extension, and lymphovascular invasion.
- Statistical analysis using Origin 6.0 and Microsoft Office Excel 2007.
Main Results:
- A total of 8,432 LNs were reviewed; 60 cases (24%) had positive LNs (274/1,982, 13.8%).
- Hypogastric/obturator (internal iliac) LNs were most frequently submitted (35.2%) and yielded the most positive LNs (46.0%).
- Optimal staging suggested examining 23 LNs for pN staging (18 primary, 5 secondary) and 4 distal LNs for pM1 staging, totaling 27 LNs.
Conclusions:
- Current lymph node (LN) evaluation in radical cystectomy specimens can be optimized.
- Examining an average of 27 lymph nodes (LNs), stratified by drainage area, is proposed for adequate pN and pM staging in urothelial carcinoma.
- Stratifying positive LNs by drainage area can enhance staging accuracy.
