366 IS PARTIAL SAMPLING OF A RADICAL PROSTATECTOMY SPECIMENS ASSOCIATED WITH MISSING OF POSITIVE MARGINS OR EXTRAPROSTATIC EXTENSIONS?

Abstract

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2012366 IS PARTIAL SAMPLING OF A RADICAL PROSTATECTOMY SPECIMENS ASSOCIATED WITH MISSING OF POSITIVE MARGINS OR EXTRAPROSTATIC EXTENSIONS? Viacheslav Iremashvili, Soum Lokeshwar, Merce Jorda, Murugesan Manoharan, Saleem A. Umar, and Mark S. Soloway Viacheslav IremashviliViacheslav Iremashvili Miami, FL More articles by this author , Soum LokeshwarSoum Lokeshwar Miami, FL More articles by this author , Merce JordaMerce Jorda Miami, FL More articles by this author , Murugesan ManoharanMurugesan Manoharan Miami, FL More articles by this author , Saleem A. UmarSaleem A. Umar Miami, FL More articles by this author , and Mark S. SolowayMark S. Soloway Miami, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.428AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The pathologic stage and surgical margin status of a radical prostatectomy (RP) specimen may directly impact subsequent patient management. The aim of our study was to determine if different methods of partial sampling affect the accuracy of detection of positive margins (PMs) and/or extraprostatic extensions (EPEs). METHODS Between January 1992 and May 2011 1,975 patients underwent open RP performed by one surgeon. We identified 808 cases that had either PM or EPE or both. In all cases a 2 mm apical margin was obtained from the most distal part of the prostate. The gland was than step-sectioned at 3-4-mm intervals in transverse planes into separate blocks according to the Stanford protocol. 697 of our cases had a diagram describing the outline of cancer areas as well as location of PM and EPE in each of the blocks. Using these diagrams we analyzed the potential outcomes of four published methods of partial sampling (Table 1). The rates of PM § and EPEs that could have been identified using each of these techniques were compared to the actual rates obtained by entire sampling. Table 1. Studied methods of partial prostate sampling No. Description Publication 1 Three “representative” sections including apical, mid and basal parts of the gland Samaratunga H, et al. Mod Pathol. 2011; 24: 6-15. 2 Alternate sections Cohen MB, et al. Am J Clin Pathol. 1994; 101: 250-2. 3 Alternate sections representing the posterior aspect of the gland in addition to one of the mid-anterior Salem S, et al. J Urol. 2010; 184: 1334-40. 4 Every section representing the posterior aspect of the gland in addition to one of the mid-anterior, supplemented by additional sections based on tumor size Sehdev AES, et al. Hum Pathol. 2001; 32: 494-9. RESULTS Of 697 RP specimens, only PMwas identified in 387 (56%) cases, only EPE in 136 (20%), and both were identified in 174 (25%). All alternative sampling methods missed a significant number of PM § and/or EPEs (p<0.001 (McNemar test) for all pairs of comparison), however the numbers of missed cases varied considerably (Figure 1) among the studied techniques. The lowest rates were noted for method 4, which would have missed only 6% of PM § and 7% of EPEs. CONCLUSIONS Most methods of partial sampling miss considerable proportion of PM § and/or EPEs. The latter was particularly dependent on the sampling technique. The only method which missed less than 10% of PM §/EPEs found on entire sampling was the technique described by Sedhev et al. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e150 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Viacheslav Iremashvili Miami, FL More articles by this author Soum Lokeshwar Miami, FL More articles by this author Merce Jorda Miami, FL More articles by this author Murugesan Manoharan Miami, FL More articles by this author Saleem A. Umar Miami, FL More articles by this author Mark S. Soloway Miami, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...