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Submission of the entire lymph node dissection for histologic examination in gynecologic-oncologic specimens. Clinical and pathologic relevance

Wagner, Heidi
Godoy, Heidi
Odunsi, Kunle
Cheney, Richard T.
Lele, Shashikant
Published in Gynecologic Oncology. 2009, vol. 115, no. 3, p. 354-356
Abstract BACKGROUND AND AIMS: 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. MATERIALS AND 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. CONCLUSION: 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.
Keywords Cost-Benefit AnalysisFemaleGenital Neoplasms, Female/diagnosis/*pathology/surgeryHumansLymph Node Excision/economics/methodsLymph Nodes/*pathology/surgeryNeoplasm StagingPoisson DistributionProspective Studies
PMID: 19811809
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MHAWECH-FAUCEGLIA, Paulette et al. Submission of the entire lymph node dissection for histologic examination in gynecologic-oncologic specimens. Clinical and pathologic relevance. In: Gynecologic Oncology, 2009, vol. 115, n° 3, p. 354-356. https://archive-ouverte.unige.ch/unige:28158

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Deposited on : 2013-05-28

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