根治性肾切除标本中是否应存在肾门淋巴结？

Should hilar lymph nodes be expected in radical nephrectomy specimens?

机构信息

Department of Pathology, University of Arkansas for Medical Sciences, 4301 West Markham slot # 517, Little Rock, AR 72205, USA.

出版信息

Pathol Res Pract. 2010 May 15;206(5):310-3. doi: 10.1016/j.prp.2010.02.002. Epub 2010 Mar 1.

DOI:10.1016/j.prp.2010.02.002

PMID:20189726

Abstract

Lymph node (LN) status is essential in staging both renal cell carcinoma (RCC) and pelvic urothelial carcinoma (PUC). The rate of regional LN involvement is influenced by pathologic tumor stage, extent of the surgical resection, and accuracy of pathologic gross examination. In this study, we assess the presence of hilar LNs in radical nephrectomies (RN) by entirely submitting the hilar fat region (HFR) for microscopic evaluation (ME). Fifty consecutive RNs from 2006 to 2008 were evaluated by a standard gross examination protocol (SGEP) which consisted of palpation and sectioning of the HFR with submission of grossly identified LNs. Subsequently, the entire HFR was re-evaluated and submitted as study's total submission protocol (TSP). The number and disease status of hilar LNs identified by the SGEP and TSP were compared. Fifty RNs (37 clear cell RCC, 6 papillary RCC, 7 PUC) were studied prospectively. Ten of the 50 RNs had LNs identified (20%) with both protocols. Four of the 50 RNs had nodal metastases (8%) with the LN sizes ranging between 1.3 and 2.5 cm (mean 1.8 cm). All nodal metastases were identified by the SGEP. In three RNs (6%), additional minute (mean 0.12 cm) negative LNs not seen by the SGEP were identified by the TSP. LNs are present in only 20% of RNs, even after complete ME of the HFR. The SGEP for identifying hilar LNs in RNs is sufficient for staging and did not lead to underreporting of LN metastases.

摘要

淋巴结 (LN) 状态对于肾细胞癌 (RCC) 和盆腔尿路上皮癌 (PUC) 的分期至关重要。区域 LN 受累的发生率受病理肿瘤分期、手术切除范围和病理大体检查准确性的影响。在这项研究中，我们通过对肾门脂肪区 (HFR) 进行完全微观评估 (ME) 来评估根治性肾切除术 (RN) 中肾门 LN 的存在。2006 年至 2008 年连续评估了 50 例 RN，采用标准大体检查方案 (SGEP)，包括 HFR 的触诊和分段，以及大体识别 LN 的提交。随后，对整个 HFR 进行重新评估并作为研究的总提交方案 (TSP) 提交。比较 SGEP 和 TSP 确定的肾门 LN 的数量和疾病状态。前瞻性研究了 50 例 RN（37 例透明细胞 RCC、6 例乳头状 RCC、7 例 PUC）。两种方案均发现 50 例 RN 中有 10 例存在 LN（20%）。50 例 RN 中有 4 例（8%）有淋巴结转移，LN 大小介于 1.3 至 2.5 厘米（平均 1.8 厘米）。所有淋巴结转移均由 SGEP 确定。在 3 例 RN 中（6%），通过 TSP 发现了 SGEP 未发现的另外几个微小结节（平均 0.12 厘米）阴性 LN。即使对 HFR 进行完全 ME，也只有 20%的 RN 存在 LN。用于识别 RN 中肾门 LN 的 SGEP 足以进行分期，并且不会导致 LN 转移的漏报。