Handling and reporting of pelvic lymphadenectomy specimens in prostate and bladder cancer: a web‐based survey by the European Network of Uropathology

Aims Pathological evaluation of lymphadenectomy specimens plays a pivotal role in accurate lymph node ( LN ) staging. Guidelines standardising the gross handling and reporting of pelvic LN dissection ( PLND ) in prostate ( PC a) and bladder ( BC a) cancer are currently lacking. This study aimed to establish current practice patterns of PLND evaluation among pathologists. Methods and results A web‐based survey was circulated to all members of the European Network of Uropathology ( ENUP ), comprising 29 questions focusing on the macroscopic handling, LN enumeration and reporting of PLND in PC a and BC a. Two hundred and eighty responses were received from pathologists throughout 23 countries. Only LN s palpable at grossing were submitted by 58%, while 39% routinely embedded the entire specimen. Average LN yield from PLND was ≥10 LNs in 56% and <10 LN s in 44%. Serial section(s) and immunohistochemistry were routinely performed on LN blocks by 42% and <1% of respondents, respectively. To designate a LN microscopically, 91% required a capsule/subcapsular sinus. In pN + cases, 72% reported the size of the largest metastatic deposit and 94% reported extranodal extension. Isolated tumour cells were interpreted as pN 1 by 77%. Deposits identified in fat without associated lymphoid tissue were reported as tumour deposits ( pN 0) by 36% and replaced LN s ( pN +) by 27%. LN s identified in periprostatic fat were included in the PLND LN count by 69%. Conclusion This study highlights variations in practice with respect to the gross sampling and microscopic evaluation of PLND in urological malignancies. A consensus protocol may provide a framework for more consistent and standardised reporting of PLND specimens.