Reliability of frozen section examination of obturator lymph nodes and impact on lymph node dissection borders during radical cystectomy: results of a prospective multicentre study by the Turkish Society of Urooncology

Abstract

to 51). The sensitivity, specificity, positive and negative predictive values of FSE for the 118 right obturator LN regions were 94.7%, 100%, 100% and 99%, respectively. The same values for the 118 left obturator LN regions were 86.7%, 100%, 100% and 98.1%, respectively. At final pathologic examination 28 of 118 (23.7%) patients had LN metastasis at obturator regions. Skipped metastasis was found in 15/90 patients (16.7%). Clinical and pathological stage of the primary tumour were found to be significant parameters for skipped metastasis ( P = 0.008 and P < 0.001, respectively). CONCLUSIONSPerforming FSE of the obturator LNs seems to be a reliable procedure for their evaluation with acceptable negative and positive predictive values. The information obtained with FSE of obturator LNs can be used to determine intraoperatively the extent of LN dissection, especially in patients with significant comorbidity. Our study also showed that if the clinical stage of the primary tumour is < cT2, the possibility of skipped metastasis is zero. KEYWORDS bladder neoplasms, cystectomy, frozen sections, lymphadenectomyWhat's known on the subject? and What does the study add? The anatomic extent of lymphadenectomy to achieve both goals, namely accurate staging and potential curative role, in bladder carcinoma patients is still in debate.We aimed in this study to evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastases and whether we can use this information to decide the extent of LN dissection during cystectomy. As a conclusion, we think that in such cases performing FSE only at obturator regions will give the information of possibility of residual positive LNs and the surgeon will then decide whether or not it is worthwhile in that case to proceed with EPLND.Study Type -Diagnostic (exploratory cohort) Level of Evidence 2b OBJECTIVETo evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastases and whether we can use this information to decide the extent of LN dissection during cystectomy. PATIENTS AND METHODSFrom August 2005 to August 2009 FSE of obturator LNs was performed in 118 patients with bladder cancer, who were undergoing radical cystectomy with extended LN dissection. Removed tissues from 12 well defined LN regions were sent separately for pathologic evaluation. The FSE results of obturator regions were compared with the final histopathologic results of these node regions. RESULTSThe mean number of removed nodes per patient was 29.4 ± 9.3 (median 28, range 12

Surgical and Chemotherapeutic Management of Regional Lymph Nodes in Bladder Cancer

“…Baltaci et al reported a sensitivity of 87% to 95% and a specificity of 100% for routine frozen section examination of obturator lymph nodes in identifying patients with node positive disease on final pathology. 22 Ugurlu et al found similar performance characteristics of frozen section analysis in assessing multiple nodal regions, reporting a sensitivity of 81% and a specificity of 100%. 23 They and others have suggested that an extended template dissection may be used only in patients with lower echelon lymph nodes that are positive on frozen section.…”

Lymph node metastasis mapping in extended lymphadenectomy to the level of the inferior mesenteric artery for bladder cancer

“…In contrast, our study found no such metastases. We consider that the number of nodes removed during extended PLND in this study was sufficient, since recent studies [5,9,[16][17][18][19] reported average numbers of removed nodes from 22 to 50. In other words, there was no significant difference in surgical technique between those studies and ours.…”

Staging and tumor biological mechanisms of lymph node metastasis in invasive urinary bladder cancer

“…perioperative FS examination of external iliac, hypogastric, and obturator lymph nodes during radical cystectomy with the intention to limit PLND has been investigated in several studies (70)(71)(72)(73). In a multicenter study, Adsan et al tested the reliability of frozen section examination of external iliac, hypogastric, and obturator lymph nodes during radical cystectomy.…”