A half a node or a whole node: a comparison of methods for submitting lymph nodes

For many neoplasms, the status of regional lymph nodes is a critical prognostic factor with direct therapeutic implications. Despite the importance of lymph node status, there is no consensus on whether lymph nodes from node dissections should be submitted in their entirety. To study this issue, for a 4-month period, all lymph nodes from node dissections were submitted in their entirety. The larger nodes were submitted systematically to determine whether the additional tissue blocks contained metastases that were not identified in the initial tissue block. We also analyzed the cost of submitting, processing, and interpreting these extra blocks. During the study period, 149 patients underwent lymph node dissections, yielding a total of 2,915 lymph nodes. Submitting the larger nodes in their entirety resulted in processing 808 additional tissue blocks that demonstrated a total of 9 additional metastases in 7 patients. In 2 of these patients, the additional metastases changed the stage of the neoplasm and may have contributed to an alteration in therapy. By using median salary figures, the estimated cost for submitting, processing, and interpreting the additional blocks was $5,935.62. Whether the additional positive nodes justify this cost should be determined by individual pathology practices.