Department of Pathology, Odense University Hospital, 5000, Odense, Denmark,
Virchows Arch. 2014 Jan;464(1):45-52. doi: 10.1007/s00428-013-1510-5. Epub 2013 Nov 21.
Pathological examinations of lymph nodes (LN) in prostate cancer patients are handled differently at various institutions. The objective of this study is to provide means to improve the guidelines by examining the impact of step sectioning on LN status in patients with intermediate and high-risk prostate cancer. Two hundred ten patients who awaited curative indented therapy were included. We first performed a standard pathological examination of the LN, followed by an extended pathological examination of the patients who were LN negative in the standard examination. The extended pathological examination included a 100-μm-deep haematoxylin and eosin (HE) section followed by a slide stained with cytokeratin AE1/AE3 and then by four HE sections at 0.5-mm intervals.The standard pathological examination detected 41 patients with LN metastasis. The remaining 169 patients had 1,185 HE sections made at the standard examination, whereas the extended examination gave additional 7,110 slides and detected 5 additional patients with LN metastasis. In all, 1,158 LN were removed. The additional LN metastases were smaller than the LN metastases found at the standard examination, mean 1.2 mm vs. 7.8 mm.Our results indicate that an extended pathological examination of LN will improve the staging of intermediate- and high-risk prostate cancer patients; however, we acknowledge that it is both costly and time consuming. We do not recommend the use of cytokeratin staining in routine staining because the immunohistochemistry did not reveal new or further information. A detailed guideline on how to handle the LN specimens at the pathological department is needed.
对前列腺癌患者的淋巴结（LN）进行病理检查在不同的机构有不同的处理方式。本研究的目的是通过检查分步切片对中高危前列腺癌患者 LN 状态的影响，为改善指南提供手段。我们纳入了 210 名等待根治性意向治疗的患者。我们首先对 LN 进行标准的病理检查，然后对标准检查中 LN 阴性的患者进行扩展的病理检查。扩展的病理检查包括 100μm 深的苏木精和伊红（HE）切片，然后用细胞角蛋白 AE1/AE3 染色的切片，再用 4 个间隔 0.5mm 的 HE 切片。标准的病理检查检测到 41 例 LN 转移患者。其余 169 例患者在标准检查中进行了 1185 个 HE 切片，而扩展检查增加了 7110 个切片，并发现了 5 例额外的 LN 转移患者。总共切除了 1158 个 LN。额外的 LN 转移比标准检查中发现的 LN 转移小，平均为 1.2mm 比 7.8mm。我们的结果表明，LN 的扩展病理检查将改善中高危前列腺癌患者的分期；然而，我们承认这既昂贵又耗时。我们不建议在常规染色中使用细胞角蛋白染色，因为免疫组化没有显示出新的或进一步的信息。病理科需要有关于如何处理 LN 标本的详细指南。
