title: Does the gross prosector impact pT3 subclassification or lymph node counts in bladder cancer?
abstract: Gross prosector analysis of perivesicular adipose tumor invasion is the sole differentiator between pT3 substages, and gross evaluation is critical to lymph node identification. Gross prosector impact on pT3 subclassification and lymph node counts in cystectomy specimens resected for bladder cancer has not been previously analyzed. Both pT3 subclassification and total number of lymph nodes removed at radical cystectomy for bladder cancer are considered important components of the pathology report; however, both have controversial prognostic significance. Our objective was to assess the impact of the gross prosector on pT3 substaging and lymph node count. Pathology reports from 560 cystectomy cases performed for primary bladder cancer were reviewed. Educational interventions regarding cystectomy gross prosector documentation were conducted. Gross prosectors did not document the presence or absence of macroscopic perivesicular adipose invasion in 17% of cases. There was a decrease in the frequency of cases lacking documentation after educational intervention (33% to 5%, P<.01). Most pT3 cases lacking documentation were classified as pT3a (75%). The percentage of pT3 cases classified as pT3a decreased after intervention (68% to 35%, P<.01). Overcounting of lymph nodes by gross prosectors was more common than undercounting (22% versus 2%). Pathology residents and prosectors with lower caseloads had more uncounted lymph packets (P<.01). In conclusion, we demonstrated an impact of the gross prosector on pT3 substaging and lymph node counts within bladder cancer resection specimens. This novel variable may confound the relationship of these parameters upon oncologic outcomes and should be incorporated into quality assurance programs.
authors.affiliation: Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. Electronic address: eric.tretter@osumc.edu.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Tretter
authors.affiliation: Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. Electronic address: joshua.ebel@osumc.edu.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Ebel
authors.affiliation: Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. Electronic address: kamal.pohar@osumc.edu.
authors.forename: Kamal S
authors.initials: KS
authors.lastname: Pohar
authors.affiliation: Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. Electronic address: debra.zynger@osumc.edu.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Zynger
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002277:Carcinoma / Q000556:secondary* / Q000601:surgery; D002983:Clinical Competence; D015653:Cystectomy; D004282:Documentation; D005260:Female; D005568:Forms and Records Control; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: Bladder cancer; Grossing; Lymph node; Prosector; pT3