Diagnosis and treatment of pelvic lymph node metastasis in bladder cancer

Abstract

Background and Methods: Bipedal lymphography and percutaneous fine needle aspiration biopsy (FNAB) of pelvic lymph node was done in 200 patients with bladder cancer. Results: A diagnosis of metastasis to the pelvic lymph node was obtained by this method in 34 patients. Of these 34 patients, only 12 (35%) were positive or suspected of having pelvic lymph node metastasis by computed tomography. Sixteen patients (47%) had unequivocally positive or highly suspicious lymphogram and 18 patients (53%) had normal lymphogram. Seventy-eight cases, including eight FNAB-positive cases, were treated by radical cystectomy and regional lymph node dissection. Sensitivity, specificity, positive predictive value and negative predictive value of FNAB were 57, 100, 100 and 91%, respectively. Thirteen FNAB-positive M0 patients could be treated by multimodality therapy and evaluated after neoadjuvant therapy by repeated lymphography and FNAB. All were changed to N0 by FNAB after neoadjuvant therapy. In eight patients treated by total cystectomy and lymph node dissection, four had down staged to pN0 but four had one positive node. In five follow-up cases without surgery, one had recurrent pelvic lymph node metastasis 35 months later. Cause-specific survival of these patients was 76% at 5 years and 57% at 8 years.Conclusions: Pretreatment diagnosis of pelvic lymph node metastasis and multimodality therapy may improve the prognosis of regional lymph node-positive bladder cancer. Because it is difficult to diagnose pN1 using FNAB, radical operation should be performed even if neoadjuvant therapy is effective and down staging is obtained.

Sialosyl‐Lex expression defines invasive and metastatic properties of bladder carcinoma

“…In this type of study, it is important to exclude patients who were treated by radiation or chemotherapy, because such treatment alters morphology significantly. 14 In the our clinic, many patients with type B tumors who underwent WLCB sampling were accumulated over a 20-year period, and we had the opportunity to study the immunohistology and retrospective clinical records of each patient. for determining the prognosis of patients with this disease; i.e., the majority of patients (19 of 31 patients) with SNH3 positive tumors had distant metastases, and the survival of patients with SNH3 positive tumors was significantly shorter compared with the survival of patients with SNH3 negative tumors (P ϭ 0.001).…”

“…13 In addition to computed tomography scanning or magnetic resonance imaging, fine-needle aspiration biopsy of the pelvic lymph nodes after bipedal lymphangiography was used to evaluate pelvic lymph node metastasis. 14 The histologic stage was determined according to the TNM classification system for malignant tumors. 12 The nuclear grading of hematoxylin and eosin-stained sections was based on the degree of nuclear atypia.…”