A standardized protocol for identifying and counting lymph nodes harvested by pelvic lymph node dissection at the time of radical cystectomy

  • Michael J. Metcalfe University of British Columbia http://orcid.org/0000-0002-2430-1890
  • Kourosh Afshar University of British Columbia
  • Alan I. So University of British Columbia
  • Edward C. Jones University of British Columbia
  • Blake C. Gilks University of British Columbia
  • Peter C. Black University of British Columbia
Keywords: Urothelial, Bladder, Cancer, Pathology, Lymph Node, Fat Emulsifying, Lymph Node Revealing, Radical Cystectomy

Abstract

Introduction: Lymph node counts have become a surrogate measure for the extent and quality of pelvic lymph node dissection (PLND) at radical cystectomy, but little consideration has been given to the methodology of lymph node processing. We report results from a prospective series comparing a conventional protocol for processing PLND specimens to a fat-emulsifying protocol. We hypothesized that the rate of node positivity would increase with the fat-emulsifying protocol.

Methods: Patients undergoing radical cystectomy for cTis-T4aN0- 1M0 urothelial carcinoma of the bladder were eligible for this trial. Palpable lymph nodes were isolated from the PLND specimens in the conventional protocol. The remaining tissue was then processed with fat-emulsifying solution to identify further nodes visually. Nodal counts were compared between techniques.

Results: The median number of nodes counted in the PLND specimens of 26 patients was 24.5 (range: 20–40) with conventional processing and 37 (range: 24–52) with the fat-emulsifying solution (p < 0.001). Three patients had lymph node positive disease detected by conventional means, and a single patient was found to have a single positive node by the fat-emulsifying solution alone. The study was closed early after conducting a futility analysis.

Conclusions: A fat-emulsifying protocol identified more lymph nodes than a conventional protocol and may be an appropriate method to standardize lymph node processing following PLND. However, we were unable to show that such a standardized approach significantly increased the rate of node positivity in patients undergoing radical cystectomy.

Author Biographies

Michael J. Metcalfe, University of British Columbia

PGY-5

Department of Urologic Sciences

University of British Columbia

Kourosh Afshar, University of British Columbia

Kourosh Afshar MD, MHSc, FRCSC, FAAP

Associate Professor, Department of Urologic Sciences

University of British Columbia

Associate Chief of Surgery, Quality and Safety,  BC Children's Hospital

Alan I. So, University of British Columbia
Associate Professor, Department of Urologic Sciences, University of British Columbia
Research Scientist, Vancouver Prostate Centre
Blake C. Gilks, University of British Columbia
Professor Department of Anatomical Pathology
Peter C. Black, University of British Columbia
Associate Professor, Department of Urologic Sciences, University of British Columbia
Research Scientist, Vancouver Prostate Centre
Consultant, BC Cancer Agency
CUA and former AUA Scholar
Published
2015-10-13
How to Cite
Metcalfe, M. J., Afshar, K., So, A. I., Jones, E. C., Gilks, B. C., & Black, P. C. (2015). A standardized protocol for identifying and counting lymph nodes harvested by pelvic lymph node dissection at the time of radical cystectomy. Canadian Urological Association Journal, 9(9-10), 337-42. https://doi.org/10.5489/cuaj.2796
Section
Original Research