Value of frozen sections of lymph nodes in pelvic lymphadenectomy in patients with invasive bladder tumor

Abstract

Aim : We examined the reliability of classical lymph node evaluation methods. We compared the results of preoperative computed tomography (CT) and perioperative frozen section examination of lymph nodes in patients on whom radical cystectomy was performed because of invasive bladder tumors. Methods : A total of 142 patients, in whom radical cystectomy was performed because of invasive bladder tumors between the years 1994 and 2005 in our clinic, and 284 pelvic lymph node regions were evaluated retrospectively. For each of the pelvic lymph node region, the conditions of the lymph nodes according to CT and in frozen sections were compared with the final pathology reports of the surgical specimens. Results : Lymph node involvement was found in 36 pelvic regions out of 284 in the final pathology. It had been possible to show only two of the 36 positive lymph nodes in preoperative CT. Frozen section results of the 29 pelvic lymph node regions out of 36 that were involved according to the final pathology were positive also according to frozen section results. On the other hand, in all the 29 lymph node regions those that were positive according to frozen section had lymph node involvement in the final pathology. Conclusions : We recommend the performance of frozen section examination on obturator plus internal iliac lymph nodes when deciding extended lymph node dissection, and the performance of extended lymph node dissection only if the result is positive.

Surgical and Chemotherapeutic Management of Regional Lymph Nodes in Bladder Cancer

“…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. 10 Baltaci et al proposed using clinical staging information as well since they found no false-negatives on frozen section analysis when limiting to patients with less than clinical stage T2 disease.…”

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.…”