Abstract: PD62-09
Sources of Funding: none

Introduction

The value of extemporary pathological examination of lymph nodes during RC using FS has been debated and is still controversial. In the majority of tertiary centers an extended or super-extended lymphadenectomy(E-SE-LAD) without intra-op evaluation of the nodes is performed. However this approach has drawbacks: 1. longer time of surgery 2. possible higher complication rate . To prevent this an intra-op path evaluation of the nodes removed can help in reducing the extent and time of surgery and complications. The objective of the study was to evaluate the path diagnosis on FS of lymph nodes during RC and to compare it to the final path report. Finally the impact of FS results on the extent of surgery was analized.

Methods

The last 74 patients who received RC with ELAD for TCC of the bladder at our center were included. Obturator, internal, external, common, pre-sacral and perivesical nodes were removed bilaterally before RC and sent immediately for FS. When 1 pos. node was detected LAD was extended to the aortic bifurcation bilaterally . If none or more than 1 node was pos. at FS LAD was stopped. Mean age was 63.5 year (58-78). Male/female ratio was : 51/23. 148 LADs were performed and nodes sent in separate containers (pelvic:obturator + internal , external, common iliac , pre-sacral,peri-vesical) for FS during RC. Pathological preparation An established path protocol for extemporary diagnosis was followed in all cases. It consisted of different passages: 1. freezing (cryostat) 2. first staining (hematossilin-Eosin) 3. cutting (5 nm thickness sections) 4. quick re-staining with hematossilin-Eosin 5. reading.

Results

The median N of nodes sent for FS was 18 from each side (36 in total) . 14/74 pts (19%) had pos. nodes at FS and all were confirmed at the final path evaluation . 3/14 pts. had only one pos. node (2 R, 1 L) and LAD was extended to the aortic bifurcation. The final path report confirmed the FS report and no further pos.nodes were detected. In one case (1/148 LADs) a node was suspicious at FS and pos. at the final path report: patient received ELAD. 10/14 pts. had more than one pos node: LAD was not extended further. The concordance between FS and final path report was 99.3% (147/148 LADs). In 2 patients the N of pos nodes at the final path examination was greater than the one found on FS (+ 5 and + 2). In both cases surgery was not changed.

Conclusions

A high concordance between intra-op FS diagnosis of lymph nodes and final path report was observed (99.3%). In 4% of patients (3/74) the surgical procedure was changed (ELND) due to the FS results. In 96% of our pts. an extended surgery was not necessary . FS resulted a valuable method for the detection of pos. nodes during RC. A well defined and strict path protocol and path/uro cooperation is the key.

Funding

none