Abstract
Prostate cancer volume correlates with stage, grade, and progression after prostatectomy. When tumor volume is measured planimetrically, results are multiplied by a correction factor to compensate for tissue shrinkage caused by processing. Injection of formalin into prostatectomy specimens was suggested for improved fixation. Our aim was to investigate how this affects the prostate volume. We studied 142 radical prostatectomy specimens. All prostates were immersed in 10% formalin. In 84 prostates (59%) we also injected 20 ml of formalin before routine fixation. The prostates were weighed unfixed after injection and after final fixation. The specimens were sliced and totally embedded. The transverse diameters of the prostates were measured on unfixed specimens and microscopic sections. The average weight loss after final fixation was 5.8 and 8.6% for formalin-injected specimens and standard-fixed specimens, respectively (p<0.001). However, when total shrinkage was estimated from the transverse diameters, there was no difference related to fixation technique (p=0.59). The average linear shrinkage was 4.5%, corresponding to a volume correction factor of 1.15. We conclude that formalin injection for fixation of prostate tissue does not influence tumor volume calculation compared to conventional fixation.
Similar content being viewed by others
References
Blackwell KL, Bostwick DG, Myers RP, Zincke H, Oesterling JE (1994) Combining prostate specific antigen with cancer and gland volume to predict more reliably pathological stage: the influence of prostate specific antigen cancer density. J Urol 151:1565–1570
Boswick DG, Graham SDJ, Napalkov P, Abrahamsson PA, di Sant’agnese PA, Algaba F, Hoisaeter PA, Lee F, Littrup P, Mostofi FK, Denis L, Schroeder F, Murphy GP (1993) Staging of early prostate cancer: a proposed tumor volume-based prognostic index. Urology 41:403
Cupp MR, Bostwick DG, Myers RP, Oesterling JE (1995) The volume of prostate cancer in the biopsy specimen cannot reliably predict the quantity of cancer in the radical prostatectomy specimen on an individual basis. J Urol 153:1543–1548
De Marzo AM, Fedor H, Gage WR, Rubin MA (2002) Inadequate formalin fixation decreases reliability of p27Kip1 immunohistochemical staining: probing optimal fixation time using high-density tissue microarrays. Human Pathol 33:756–760
DeMarzo AM, Nelson WG, Isaacs WB, Epstein JI (2003) Pathological and molecular aspects of prostate cancer. Lancet 361:955–964
Epstein JI, Oesterling JE, Walsh PC (1988) Tumor volume versus percentage of specimen involved by tumor correlated with progression in stage A prostatic cancer. J Urol 139:980–984
Epstein JI, Carmichael M, Partin AW, Walsh PC (1993) Is tumor volume an independent predictor of progression following radical prostatectomy? A multivariate analysis of 185 clinical stage B adenocarcinomas of the prostate with 5 years of follow up. J Urol 149:1478–1481
Epstein JI, Walsh PC, Carmichael M, Brendler CB (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 271:368–374
Greene DR, Egawa S, Neerhut G, Flanagan W, Wheeler TM, Scardino PT (1991) The distribution of residual cancer in radical prostatectomy specimens in stage A prostate cancer. J Urol 145:324–329
Häggarth L, Busch C, Norberg M, Häggman M, Norlen BJ, Egevad L (2005) Prediction of the volume of large prostate cancers by multiple core biopsies. Scand J Urol Nephrol 39:380–386
Häggman M, Nybacka O, Nordin B, Busch C (1994) Standardized in vitro mapping with multiple core biopsies of total prostatectomy specimens: localization and prediction of tumour volume and grade. Br J Urol 74:617–625
Hoedemaeker RF, Ruijter ET, Ruizeveld-de Winter JA, van der Kaa CA, the Biomed II MPC Study Group, van der Kwast TH (1998) Processing radical prostatectomy specimens. J Urol Pathol 9:211–222
Humphrey PA (1993) Complete histologic serial sectioning of a prostate gland with adenocarcinoma. Am J Surg Pathol 17:468–472
Humphrey PA, Walther PJ, Currin SM, Vollmer RT (1991) Histologic grade, DNA ploidy, and intraglandular tumor extent as indicators of tumor progression of clinical stage B prostatic carcinoma. A direct comparison. Am J Surg Pathol 15:1165–1170
Kikuchi E, Scardino PT, Wheeler TM, Slawin KM, Ohori M (2004) Is tumor volume an independent prognostic factor in clinically localized prostate cancer? J Urol 172:508–511
Lerner SE, Blute ML, Zincke H (1996) Risk factors for progression in patients with prostate cancer treated with radical prostatectomy. Semin Urol Oncol 14:12–20; discussion 21
McNeal JE (1992) Cancer volume and site of origin of adenocarcinoma in the prostate: relationship to local and distant spread. Hum Pathol 23:258–266
McNeal JE (1997) Prostate cancer volume. Am J Surg Pathol 21:1392
McNeal JE, Bostwick DG, Kindrachuk RA, Redwine EA, Freiha FS, Stamey TA (1986) Patterns of progression in prostate cancer. Lancet 1:60–63
Miller GJ (1989) Histopathology of prostate cancer: prediction of malignant behavior and correlation with ultrasonography. Urology 33:18–26
Noguchi M, Stamey TA, McNeal JE, Yemoto CE (2000) Assessment of morphometric measurements of prostate carcinoma volume. Cancer 89:1056–1064
Norberg M, Holmberg L, Wheeler T, Magnusson A (1994) Five year follow-up after radical prostatectomy for localized prostate cancer-a study of the impact of different tumor variables on progression. Scand J Urol Nephrol 28:391–399
Partin AW, Epstein JI, Cho KR, Gittlesohn AM, Walsh PC (1989) Morphometric measurement of tumor volume and percent of gland involvement as predictors of pathological stage in clinical stage B prostate cancer. J Urol 141:341–345
Schmid H-P, McNeal JE (1992) An abbreviated standard procedure for accurate tumor volume estimation in prostate cancer. Am J Surg Pathol 16:184–191
Schned AR, Wheeler KJ, Hodorowski K, Heaney JA, Ernstoff MS, Amdur RJ, Harris RD (1996) Tissue-shrinkage correction factor in the calculation of prostate cancer volume. Am J Surg Pathol 20:1501–1506
Stamey TA, McNeal JE, Freiha FS, Redwine E (1988) Morphometric and clinical studies on 68 consecutive radical prostatectomies. J Urol 139:1235–1241
Stamey TA, McNeal JE, Yemoto CM, Sigal BM, Johnstone IM (1999) Biological determinants of cancer progression in men with prostate cancer. JAMA 281:1395–1400
Acknowledgement
We thank the laboratory technicians Ingeborg May and Ulf Hörnberg for excellent assistance with the handling of prostatectomy specimens.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jonmarker, S., Valdman, A., Lindberg, A. et al. Tissue shrinkage after fixation with formalin injection of prostatectomy specimens. Virchows Arch 449, 297–301 (2006). https://doi.org/10.1007/s00428-006-0259-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00428-006-0259-5