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Does the gross prosector impact pT3 subclassification or lymph node counts in bladder cancer?

Eric M Tretter¹, Joshua J Ebel², Kamal S Pohar²

¹Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.

Human Pathology

|December 21, 2016

Summary

Gross prosector documentation significantly impacts bladder cancer staging and lymph node counts. Improved training reduced documentation errors, highlighting the prosector

Keywords:

Bladder cancer Grossing Lymph node Prosector pT3

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Area of Science:

Uropathology
Surgical Pathology
Oncology

Background:

Accurate staging of bladder cancer is crucial for prognosis and treatment.
Perivesicular adipose tumor invasion and lymph node counts are key pathological findings in cystectomy specimens.
The role of the gross prosector in influencing these parameters has not been previously investigated.

Purpose of the Study:

To evaluate the impact of the gross prosector on pT3 substaging and lymph node enumeration in bladder cancer specimens.
To assess the effectiveness of educational interventions aimed at improving prosector documentation.

Main Methods:

Retrospective review of 560 radical cystectomy pathology reports for primary bladder cancer.
Analysis of documentation rates for perivesicular adipose invasion before and after educational interventions.
Comparison of lymph node counts and identification of factors associated with undercounting.

Main Results:

Gross prosectors failed to document perivesicular adipose invasion in 17% of cases, decreasing to 5% after intervention (P<.01).
Cases lacking documentation were often misclassified as pT3a, with the frequency of pT3a classification decreasing post-intervention (68% to 35%, P<.01).
Overcounting of lymph nodes occurred in 22% of cases, more frequently among residents and those with lower caseloads.

Conclusions:

The gross prosector significantly influences pT3 substaging and lymph node counts in bladder cancer specimens.
Educational interventions can improve prosector documentation accuracy.
Prosector variability may confound the prognostic significance of these parameters and warrants inclusion in quality assurance.