title: Stage specific lymph node metastasis mapping in radical cystectomy specimens.
abstract: OBJECTIVE
  We provide an accurate map of lymph node (LN) metastasis in patients with bladder cancer undergoing radical cystectomy and pelvic lymph node dissection.
  
  
  METHODS
  We analyzed data on 176 consecutive patients operated on by the same surgeon. The extent of node dissection included presacral, bilateral common iliac and pelvic, and perivesical. The number of LNs removed from each site and the number of metastases bearing nodes were recorded separately. Stage specific maps were constructed.
  
  
  RESULTS
  The median number of LNs removed was 25 (range 2 to 80). Metastases were found in the lymph nodes of 43 patients (24.4%) and the median number of positive nodes was 3 (range 1 to 63). Of these patients 22 (51%) had lymph node involvement at more than 1 site. The mean number of positive/total LNs sampled +/- SD in LN positive cases was 26% +/- 28% and the median was 13% (range 1.9 to 100%). Only 1 of the patients with pT1 (3.6%) had LN metastases, which was in the pelvic region. Only 2 of the patients with pT2 (3%) had LN metastases outside of the true pelvis and perivesical sites. Of patients with pT3 or pT4 16% had LN metastases outside the common boundaries for standard LN dissection, namely the common iliac artery and at or above aortic bifurcation.
  
  
  CONCLUSIONS
  We present a detailed map of regional LN involvement in patients treated with radical cystectomy and lymph node dissection for transitional cell cancer of the bladder. Extensive LN dissection is essential for the complete removal of disease and accurate staging.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Methodist and Saint Luke's Episcopal Hospitals, Houston, Texas 77030, USA.
authors.forename: Amnon
authors.initials: A
authors.lastname: Vazina
authors.forename: Daniel
authors.initials: D
authors.lastname: Dugi
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Jeff
authors.initials: J
authors.lastname: Evans
authors.forename: Richard
authors.initials: R
authors.lastname: Link
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000556:secondary* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*