Handling and Reporting of Pelvic Lymphadenectomy Specimens in Prostate and Bladder Cancer: A Web‐based Survey by the European Network of Uropathologists (ENUP)

Abstract

Introduction

Pathologic evaluation of lymphadenectomy specimens plays a pivotal role in accurate lymph node (LN) staging. Guidelines standardizing the gross handling and reporting of pelvic LN dissection (PLND) in prostate (PCa) and bladder (BCa) cancer are currently lacking. This study aimed to establish current practice patterns of PLND evaluation among pathologists.

Methods

A web‐based survey was circulated to all members of the European Network of Uropathology (ENUP), comprising 29 questions focusing on the macroscopic handling, LN enumeration and reporting of PLND in PCa and BCa.

Results

280 responses were received from pathologists across 23 countries. Only LNs palpable at grossing were submitted by 58%, while 39% routinely embedded the entire specimen. Average LN yield from PLND was ≥10LNs in 56% and <10LNs in 44%. Serial section(s) and immunohistochemistry were routinely performed on LN blocks by 42% and <1% of respondents respectively. To designate a LN microscopically, 91% required a capsule/subcapsular sinus. In pN+ cases, 72% reported the size of the largest metastatic deposit and 94% reported extranodal extension. Isolated tumour cells were interpreted as pN1 by 77%. Deposits identified in fat without associated lymphoid tissue were reported as tumour deposits (pN0) by 36% and replaced LNs (pN+) by 27%. LNs identified in periprostatic fat were included in the PLND LN count by 69%.

Conclusion

This study highlights variations in practice with respect to the gross sampling and microscopic evaluation of PLND in urologic malignancies. A consensus protocol may provide a framework for more consistent and standardized reporting of PLND specimens.

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