Composite cytological smears of pelvic lymph nodes at the time of radical prostatectomy to identify nodal metastases.
Many urologists will abort a radical prostatectomy (RP) after intraoperative identification of regional lymph node (LN) metastases because RP in these patients is not curative. Because frozen section techniques are time consuming and incompletely sample LNs, we evaluated the efficacy of performing a composite cytological smear (CCS) by sampling all grossly identifiable LNs. Two hundred and fifty RPs performed from November 1991 to June 1992 yielded on permanent section 33 (+) pelvic lymph node dissections (PLNDs) (6.6%) in 25 RPs (10%). Eleven (33%) of the 33 PLNDs with metastases were grossly suspicious, all were identified by CCS (median percentage of positive LNs per PLND = 33; median size of the largest metastasis = 11 mm). Of the remaining 22 grossly negative PLNDs with tumor, only seven (32%) were detected by CCS (median percentage of positive LNs per PLND = 13; median size of largest metastasis = 3 mm). In the 15 cases missed by CCS the median percentage of positive LNs per PLND was 14, and the median size of the largest metastasis was 1 mm. This method reliably detected LN metastases measuring more than 2 mm as long as the positive LN was grossly recognizable as an LN and thus sampled by CCS. In conclusion, CCS is highly specific but insensitive for the detection of limited numbers of micrometastases, which are the most common type of metastases in patients with low clinical stage disease. A combined technique employing frozen sections on smaller nodes and CCS on larger nodes may be more effective in identifying small metastatic deposits.
Bastacky
S
S
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
Silver
S A
SA
Epstein
J I
JI
D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D003584:Cytological Techniques; D006801:Humans; D007430:Intraoperative Care; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery