Tretter Eric M, Ebel Joshua J, Pohar Kamal S, Zynger Debra L
Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
Hum Pathol. 2017 Mar;61:190-198. doi: 10.1016/j.humpath.2016.12.009. Epub 2016 Dec 16.
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.
对膀胱周围脂肪肿瘤浸润进行大体解剖分析是pT3亚分期之间的唯一区分因素，而大体评估对淋巴结识别至关重要。此前尚未分析过大体解剖对膀胱癌膀胱切除术标本中pT3亚分类和淋巴结计数的影响。pT3亚分类和膀胱癌根治性膀胱切除术中切除的淋巴结总数均被认为是病理报告的重要组成部分；然而，两者的预后意义都存在争议。我们的目的是评估大体解剖对pT3亚分期和淋巴结计数的影响。回顾了560例原发性膀胱癌膀胱切除术病例的病理报告。针对膀胱切除术大体解剖记录进行了教育干预。在17%的病例中，大体解剖未记录是否存在肉眼可见的膀胱周围脂肪浸润。教育干预后，缺乏记录的病例频率有所下降（从33%降至5%，P<0.01）。大多数缺乏记录的pT3病例被分类为pT3a（75%）。干预后，分类为pT3a的pT3病例百分比下降（从68%降至35%，P<0.01）。大体解剖对淋巴结的计数错误中，计数过多比计数过少更常见（22%对2%）。病例量较低的病理住院医师和解剖人员有更多未计数的淋巴结包块（P<0.01）。总之，我们证明了大体解剖对膀胱癌切除标本中的pT3亚分期和淋巴结计数有影响。这个新的变量可能会混淆这些参数与肿瘤学结局之间的关系，应纳入质量保证计划。
