Handling and reporting of pelvic lymphadenectomy specimens in prostate and bladder cancer: a web‐based survey by the European Network of Uropathology

Abstract

Aims: Pathological evaluation of lymphadenectomy specimens plays a pivotal role in accurate lymph node (LN) staging. Guidelines standardising the gross handling and reporting of pelvic LN dissection (PLND) in prostate (PCa) and bladder (BCa) cancer are currently lacking. This study aimed to establish current practice patterns of PLND evaluation among pathologists. Methods and results: A web-based survey was circulated to all members of the European Network of Uropathology (ENUP), comprising 29 questions focusing on the macroscopic handling, LN enumeration and reporting of PLND in PCa and BCa. Two hundred and eighty responses were received from pathologists throughout 23 countries. Only LNs palpable at grossing were submitted by 58%, while 39% routinely embedded the entire specimen. Average LN yield from PLND was ≥10 LNs in 56% and <10 LNs in 44%.Serial section(s) and immunohistochemistry were routinely performed on LN blocks by 42% and <1% of respondents, respectively. To designate a LN microscopically, 91% required a capsule/subcapsular sinus. In pN+ cases, 72% reported the size of the largest metastatic deposit and 94% reported extranodal extension. Isolated tumour cells were interpreted as pN1 by 77%. Deposits identified in fat without associated lymphoid tissue were reported as tumour deposits (pN0) by 36% and replaced LNs (pN+) by 27%. LNs identified in periprostatic fat were included in the PLND LN count by 69%. Conclusion: This study highlights variations in practice with respect to the gross sampling and microscopic evaluation of PLND in urological malignancies. A consensus protocol may provide a framework for more consistent and standardised reporting of PLND specimens.

Pathological reporting of cystectomy lymph nodes: a retrospective analysis of experience in Paris

“…LN metastasis is a predictor of poor outcome in bladder UC [17]. LN counts and the resulting LND likely suffer from the lack of established standards in gross handling, counting and reporting of PLND specimens [8][9][10]. The pathologist's practical approach is to palpate and dissect LN from the surrounding adipose tissue.…”

“…A further issue is a frequently requested minimum number of LN for diagnosis. All these measures suffer from the lack of established standards in gross handling, counting, and reporting of PLND specimens [8][9][10].…”

Is the pN category in radical cystectomy dependent on the pathologist dissection?

“…The minimum number of LN needed for more accurate bladder cancer pN staging is still uncertain. To date, nine LN have been considered sufficient [7], but in routine clinical practice it is usual to obtain from 4 to 16 [6], and the American Joint Committee on Cancer recommends more than 12 LN [8]. Nevertheless, in general, authors agree that as more tissue is studied, more LN are found.…”

“…The number of LN detected by the pathologist may depend on the extent of the LDN [3], the inter-individual variability among patients [4], and the handling and interpretation of the pathological specimen [5]. Currently, consensus is lacking on the optimal handling and reporting of LDN specimens [6], which may explain differences in the interpretation between an LN and a simple lymphoid aggregate and in the methodology used to evaluate LN and the corresponding final count [5]. LDN pathological dissection is one variable that can be standardized.…”