Value of frozen section analysis of enlarged lymph nodes during radical nephrectomy for renal cell carcinoma.
OBJECTIVE
To avoid unnecessary lymphadenectomy for renal cell cancer (RCC) in patients with retroperitoneal enlarged lymph nodes (ELNs).


METHODS
Frozen section examination (FSE) of ELNs was used to evaluate the lymphatic status. In the present study, 114 patients with RCC underwent FSE of ELNs and concurrent regional lymphadenectomy. The results of FSE were compared with the final histopathologic results of lymphadenectomy. Some clinical tumor characteristics were also considered to improve the evaluation effect of the FSE. Multiple regression analysis was applied to define the independent risk factors for lymphatic metastasis.


RESULTS
The final histopathologic results indicated that 36 patients (31.6%) had nodal metastases. In these 36 patients, the FSE of ELNs revealed positive findings in 32 patients and negative findings in 4 patients. The sensitivity, specificity, concordance, and false-negative rate of FSE was 88.9%, 100%, 96.5%, and 11.1%, respectively. Multivariate analysis revealed that distant metastasis and high T stage (T3-T4) were independent risk factors for lymphatic metastasis. When FSE indicated negative results, no nodal metastases were found (64 patients) without these 2 risk factors.


CONCLUSIONS
ELNs in patients with RCC do not necessarily indicate metastatic disease, and more than one half of ELNs were benign. FSE of ELNs can be used to evaluate the lymphatic status. Using the findings from FSE and the clinical characteristics of the primary tumor, we can avoid unnecessary lymphadenectomy in patients with retroperitoneal ELNs.
Ming
Xia
X
Department of Urology, Peking Union Medical College Hospital, Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Ningshu
Lin
L
Hanzhong
Li
L
Zhongming
Huang
H
Tonghua
Liu
L
D000328:Adult; D000368:Aged; D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D012187:Retroperitoneal Space; D012680:Sensitivity and Specificity