title: Complete Tissue Submission to Increase Lymph Node Detection in Pelvic Lymph Node Packets Submitted for Patients Undergoing Radical Prostatectomy and Radical Cystectomy.
abstract: BACKGROUND
  Pelvic lymphadenectomy has prognostic and therapeutic implications in both bladder and prostate cancer. Pelvic lymphadenectomy specimens are fatty and identification of lymph nodes (LNs) can be difficult during the grossing process. We investigated the benefit of a new grossing method requiring entire LN packet submission.
  
  
  METHODS
  We introduced a new grossing protocol requiring total submission of LN packets for patients undergoing radical prostatectomy (RP) or radical cystectomy (RC). A retrospective review was performed to evaluate clinical and pathologic data for RP (n = 59) and RC (n = 56) cases performed 18 months prior to and 18 months following implementation of the new lymphadenectomy grossing protocol.
  
  
  RESULTS
  For RP and RC cases, significantly more LNs were found when total LN packets were submitted with the new technique: mean 14.1 versus 8.7, and mean 25.2 versus 15.9, respectively ( P = .007, P = .011). For RP cases, there was no significant change in the number of LN packets submitted for evaluation from the operating room ( P = .76). For RC cases, more LNs were found with the new technique despite a significantly fewer number of LN packets sent from the operating room in the cohort that were processed with the new technique: mean 2.2 versus 4.0 LN packets ( P < .001). Significantly more paraffin blocks were required using the new grossing method for both RP and RC: mean 13.53 versus 6.9 and mean 19.0 versus 12.4, respectively ( P < .001, P = .018).
  
  
  CONCLUSIONS
  Submitting all additional fatty tissue after palpable identification of LNs can significantly increase the detection of LNs in RP and RC cases.
authors.affiliation: 1 Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.|2 Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.affiliation: 3 Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Tracht
authors.affiliation: 3 Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Eleanor R
authors.initials: ER
authors.lastname: McIntosh
authors.affiliation: 1 Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Win Shun
authors.initials: WS
authors.lastname: Lai
authors.affiliation: 1 Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.|3 Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Gordetsky
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010388:Pelvis / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: lymph node yield; lymphadenectomy; prostate adenocarcinoma; urothelial carcinoma