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  • Optimal sampling of pelvic lymphadenectomy specimens following radical prostatectomy: is complete tissue submission justified?

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Optimal sampling of pelvic lymphadenectomy specimens following radical prostatectomy: is complete tissue submission justified?
  1. Sarah Ni Mhaolcatha,
  2. Elaine Power,
  3. Nick Mayer,
  4. Susan Prendeville
  1. Department of Histopathology, Cork University Hospital, Cork, Ireland
  1. Correspondence to Dr Susan Prendeville, Department of Histopathology, Cork University Hospital, Cork, Ireland; susan.prendeville{at}hse.ie

Abstract

There is currently no consensus among pathologists on the optimal method of sampling pelvic lympadenectomy specimens (PLND) in prostate cancer. We evaluated the impact of complete PLND submission on lymph node (LN) yield, detection of metastasis and laboratory workload in a series of 141 cases. Following isolation of grossly identifiable LNs/potential LNs, the remaining fatty tissue was embedded in toto. Complete PLND submission increased median LN yield from 10 (1–42) to 17 (3–57). Metastatic deposits were identified in nine non-palpable LNs, which altered the pN category in four cases (3%). The primary tumour (pT) was grade group ≥3 and/or pT3 at radical prostatectomy in 96% of pN+ cases. A median of seven additional blocks (1–28) was required for complete tissue embedding. Our findings indicate that submission of the entire fat can optimise PLND assessment but has a significant impact on laboratory workload. Complete submission of selected high-risk cases may be a reasonable alternative.

  • lymph node
  • lymphadenectomy
  • prostate cancer

https://doi.org/10.1136/jclinpath-2019-205839

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    Footnotes

    • Handling editor Dhirendra Govender.

    • SNM and EP contributed equally.

    • Contributors All authors were involved in study design and data collection. The manuscript was drafted by SP. All authors approved the final manuscript prior to submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Institutional ethical approval was obtained to conduct the study

    • Provenance and peer review Not commissioned; externally peer reviewed.