Does the gross prosector impact pT3 subclassification or lymph node counts in bladder cancer?

Publication date: Available online 16 December 2016
Source:Human Pathology
Author(s): Eric M. Tretter, Joshua J. Ebel, Kamal S. Pohar, Debra L. Zynger
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 were conducted regarding cystectomy gross prosector documentation. 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). The majority of pT3 cases lacking documentation were classified as pT3a (75%). The percent of pT3 cases classified as pT3a decreased after intervention (68% to 35%, P<.01). Over-counting of lymph nodes by gross prosectors was more common than under-counting (22% vs. 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.



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