Submission of the entire lymph node dissection for histologic examination in gynecologic-oncologic specimens. Clinical and pathologic relevance.
OBJECTIVE
Lymph node (LN) status in gynecologic malignancies plays an important role in patient staging, management, and prognosis. Therefore, an adequacy of LN harvest is crucial. The aim of this study is to determine whether the submission of the entire LN dissection for histologic examination will affect patients' outcome or clinical stage. We also evaluated the time required and cost-effectiveness for the laboratory.


METHODS
A prospective study of 134 surgical cases from various gynecologic malignancies was conducted. The LN dissection specimen was performed using a conventional manual node dissection method with all the remaining fat being submitted in additional cassettes. One pathologist evaluated (1) the number and status of palpable LNs identified by the conventional method as well as the number of tissue cassettes and (2) the number, size, and status of the non-palpable LNs as well as the number of tissue cassettes.


RESULTS
The palpable LNs ranged from 0 to 36 with average 14.8 LNs per case (Poisson 95% CI: 14.1-15.4). The additional non-palpable LNs ranged from 0 to 16 with an average of 3.1 (Poisson 95% CI: 2.8-3.4). In only one case, a 3-mm non-palpable LN with metastasis was identified; however, it did not affect tumor staging or patient management.


CONCLUSIONS
The impact on patient outcome is minimal and it does not prove to be cost and time effective when submitting the entire LN dissection specimen in gynecologic malignancies. However, this method could be justified in selective cases in which the manual node dissection does not reveal an adequate number of LNs.
Mhawech-Fauceglia
Paulette
P
Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY 14263, USA. pmhawech1@yahoo.com
Herrmann
Francois R
FR
Wagner
Heidi
H
Godoy
Heidi
H
Odunsi
Kunle
K
Cheney
Richard T
RT
Lele
Shashikant
S
D003362:Cost-Benefit Analysis; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision / Q000191:economics / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D016012:Poisson Distribution; D011446:Prospective Studies