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The impact of complete embedding of remaining tissue in gynecological lymph node dissection specimen in surgical pathology on lymph node yield: is it clinically relevant?

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Abstract

The assessment of nodal metastases in gynecological surgical specimen is an important staging parameter, directing further therapeutic procedures. Since the number of lymph nodes (LNs) removed is seen as an indicator of surgical and pathological quality, the demand for higher lymph node (LN) counts is raising. The goal of this prospective study was the comparison between lymph node counts of macroscopically detectable LNs and the LN yield by complete embedding and proceeding of all submitted LN-containing tissue in the pathology laboratory. One hundred six cases of cervical, uterine, or ovarian cancer, treated in three different hospitals within 3 years, were analyzed. All tissue submitted to the pathology from the surgically performed LN dissections was completely dissected and embedded in the institute of pathology. Subsequently, the amount of LN of all macroscopically detectable nodes was compared to the final histologically reached numbers of LN. Furthermore the histologically visible area of the LNs and their metastases was analyzed to assess the relation of LN numbers to the whole examined LN area. Complete embedding raises the average number of LN counted by 3 to 7 but did only minimally increase the LN area for microscopical examination by about 5% due to the small area of the additional LNs in the remaining fat tissue. The staging was in no case altered by complete embedding, even when additional nodal metastases were detected in the remaining fat tissue, since this was only seen in cases which had already metastatic nodes. Complete embedding of LN-containing tissue did not provide relevant additional staging information and seems therefore unnecessarily laborious, careful pathological work-up assumed.

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Abbreviations

H&E :

Hematoxylin and eosin stain

LN:

Lymph node

LNs :

Lymph nodes

LNM :

Lymph node metastasis

LNMs :

Lymph node metastases

TNM :

Tumor node metastasis

UICC :

Union internationale contre le cancer

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Authors and Affiliations

  1. Institute of Pathology, Uniklinik RWTH Aachen, Aachen, Germany

    Julia Andruszkow, Ruth Knüchel & Jörg Jäkel

  2. Clinic for Gynecology and Obstetrics, Uniklinik RWTH Aachen, Aachen, Germany

    Ivo Meinhold-Heerlein & Brigitte Winkler

  3. Clinic for Gynecology and Obstetrics, Luisenhospital Aachen, Academic Teaching Hospital of RWTH Aachen, Aachen, Germany

    Benjamin Bruno

  4. Institute of Pathology, Mainz University Medical Center, Mainz, Germany

    Jörg Jäkel

Authors
  1. Julia Andruszkow
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  2. Ivo Meinhold-Heerlein
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  4. Benjamin Bruno
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  5. Ruth Knüchel
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Authorship of all authors is based on the following:

• Substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work; and

• Drafting the work or revising it critically for important intellectual content; and

• Final approval of the version to be published; and

• Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Jörg Jäkel.

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Ethical standards

The present study follows the guidelines of the revised UN declaration of Helsinki in 1975 and its latest amendment in 2008 (6th revision) and was approved by the Local Research Ethical Committee (No. 244/14).

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The authors declare that they have no conflict of interest.

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Andruszkow, J., Meinhold-Heerlein, I., Winkler, B. et al. The impact of complete embedding of remaining tissue in gynecological lymph node dissection specimen in surgical pathology on lymph node yield: is it clinically relevant?. Virchows Arch 473, 183–188 (2018). https://doi.org/10.1007/s00428-018-2363-8

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  • DOI: https://doi.org/10.1007/s00428-018-2363-8

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