Saunders KE, Cody Craig J, Hoerres DL, Maygarden SJ, Wobker SE. Less Is More.
Am J Clin Pathol 2022;
158:383-388. [PMID:
35608539 DOI:
10.1093/ajcp/aqac064]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES
Neoadjuvant chemotherapy (NAC) confers a survival advantage for muscle-invasive bladder cancer and is now recommended for chemotherapy-eligible patients. NAC may result in absent gross tumor, and current cystectomy gross examination protocols do not specify approach for these cases.
METHODS
We included cystectomies performed from 2010 to 2018, capturing a period pre- and post-NAC recommendations. Gross descriptions were reviewed and slides of patients who received NAC were evaluated for microscopic tumor, number of blocks with tumor, and location of those blocks.
RESULTS
We identified 239 radical cystectomies for bladder cancer (147 NAC, 92 non-NAC). Gross lesions were not identified for 91 cases. NAC cases had more total blocks submitted (mean, 17.5) compared with non-NAC cases (mean, 16.6). More NAC cases had additional blocks submitted (20 cases) compared with non-NAC cases (2), which were more frequently additional random sections. Of 108 NAC cases with residual carcinoma, only 2 (1.9%) were upstaged on additional random sections.
CONCLUSIONS
At our institution, NAC and non-NAC cases are grossed with similar numbers of initial blocks; however, NAC cases are more likely to submit additional sections of gross lesions and random bladder without significant changes in stage. Our data suggest current gross examination protocols are sufficient for NAC cystectomies.
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