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Occult Metastases in Pelvic Lymphadenectomy Specimens From Patients With Urothelial Carcinoma of the Bladder
- Source :
- Urology. 94
- Publication Year :
- 2016
-
Abstract
- To identify occult metastases within lymph nodes (LNs) reported as negative by routine histologic evaluation. In patients with high-grade, muscle-invasive urothelial carcinoma (UC) of the bladder, pelvic lymphadenectomy during radical cystectomy demonstrates a survival advantage, increasing with the number of LNs removed, even if negative for metastatic disease. This finding may potentially be explained by the presence of occult metastases.Radical cystectomy specimens with high-grade UC invading the perivesical tissue and negative LNs (pT3N0) between 2000 and 2014 were reviewed. Five levels were cut for each LN block. Two sections were cut per level: 1 stained for hematoxylin and eosin and 1 for AE1/AE3. Micrometastases were defined as tumor deposits0.2 mm but2 mm. Isolated tumor cells were defined as ≤0.2 mm. Medical records and survival data were reviewed.We identified 21 cases, consisting of 370 lymph nodes. Six of 21 patients (29%) had occult metastases, including 5 occult metastatic UC and 1 occult metastatic prostate adenocarcinoma. There were 10 positive LNs; 2 macrometastases, 2 micrometastases, and 6 with ITCs. Two of 6 patients (33%) had lymphovascular invasion identified in the primary tumor. Kaplan-Meier analysis showed no significant difference in overall survival between the group of patients who remained N0 versus those upstaged due to discovery of occult metastases (P-value = .42).In patients with pT3 UC undergoing cystectomy, we demonstrated the presence of occult metastases in 29% of patients. The high percentage of occult metastases present in these cases possibly explains the proven survival advantage of removing "negative" LNs. This finding might also have implications in the histologic evaluation of LNs.
- Subjects :
- Male
Pathology
medicine.medical_specialty
Lymphovascular invasion
Urology
medicine.medical_treatment
Urinary Bladder
030232 urology & nephrology
H&E stain
Cystectomy
Pelvis
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Aged
Retrospective Studies
Carcinoma, Transitional Cell
Urinary bladder
business.industry
Retrospective cohort study
medicine.disease
Primary tumor
Occult
medicine.anatomical_structure
030220 oncology & carcinogenesis
Lymphatic Metastasis
Lymph Node Excision
Female
Radiology
Lymph
business
Subjects
Details
- ISSN :
- 15279995
- Volume :
- 94
- Database :
- OpenAIRE
- Journal :
- Urology
- Accession number :
- edsair.doi.dedup.....d2f5832402835140e5bf274c64991676