Accurate Determination of the Pathological Stage with the Gross Dissection Protocol for Radical Cystectomy (GDPRC) in Daily Routine Diagnostics

Abstract

Purpose: The currently protocol for reporting urinary bladder cancer in radical cystectomies may exhibit limitations in the diagnostic accuracy, such as the risk for understaging, especially of cases in prostatic involvement. Difficulty exists in the verification of stage pT0 and assessment of surgical margins is suboptimal. Eliminate the potential compromises in sampling, we developed a daily practice gross dissection protocol where the radical cystectomies were totally embedded and evaluated histologically in whole-mount sections.

Methods: Here were reported the first 138 consecutive specimens from 99 men and 39 women from 2008 to the first quarter of 2012 inclusive; 9.2 macroblocks and 14 standard blocks were examined on overage. The incidence of cancer stages of our series was compared with the incidence of cancer stages, determined by retrieving the stage data of 15586 radical cystectomies from the literature. The differences were analyzed with the one-sample z-test (p <0.05).

Results: The following values were obtained (the first refers to our series): pT0 8.7% and 6.1%; pTa 0.7% and 2.9%; pTis 2.9% and 6%; pT1 15.2% and 15.5%; pT2 21% and 23.3%; pT3 34.8% and 34.3%; and pT4 16.7% and 11%.

Conclusion: Our findings closely reflected the means of the published statistical data based on a large number of cases. The differences were due to the more detailed processing: the case numbers in groups pTis-pT2 were comparatively low, those in groups pT3-pT4 were higher. The difference found in group pT4 was significant. (p = 0.0494) With this method only those samples were regarded as pT0 in which the granulomatous area and the haemosiderin deposition indicative of the earlier intervention were observable and the entire preparation was tumor-free. Although our protocol was three times more expensive than the currently used and the reporting time took four hours by identifying all features that can guide postoperative treatment has the monopoly of diagnostic accuracy.

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Cite this article as:  Sükösd F, Iványi B, Pajor L. Accurate Determination of the Pathological Stage with the Gross Dissection Protocol for Radical Cystectomy (GDPRC) in Daily Routine Diagnostics . Int J Cancer Ther Oncol 2015; 3(4):3407.

[This abstract was presented at the BIT’s 8^th Annual World Cancer Congress, which was held from May 15-17, 2015 in Beijing, China.]