The significance of the extent of tissue embedding for the detection of incidental prostate carcinoma on transurethral prostate resection material: the more, the better?

Abstract

The aim of this study is to investigate the incidental prostate cancer (iPCa) detection rates of different embedding methods in a large, contemporary cohort of patients with bladder outlet obstruction (BOO) treated with transurethral surgery. We relied on an institutional tertiary-care database to identify BOO patients who underwent either transurethral loop resection or laser (Holmium:yttrium-aluminium garnet) enucleation of the prostate (HoLEP) between 01/2012 and 12/2019. Embedding methods differed with regard to the extent of the additional prostate tissue submitted following the first ten cassettes of primary embedding (cohort A: one [additional] cassette/10 g residual tissue vs. cohort B: complete embedding of the residual tissue). Detection rates of iPCa among the different embedding methods were compared. Subsequently, subgroup analyses by embedding protocol were repeated in HoLEP-treated patients only. In the overall cohort, the iPCa detection rate was 11% (46/420). In cohort A (n = 299), tissue embedding resulted in a median of 8 cassettes/patient (range 1-38) vs. a median of 15 (range 2-74) in cohort B (n = 121) (p < .001). The iPCa detection rate was 8% (23/299) and 19% (23/121) in cohort A vs. cohort B, respectively (p < .001). Virtual reduction of the number of tissue cassettes to ten cassettes resulted in a iPCa detection rate of 96% in both cohorts, missing one stage T1a/ISUP grade 1 carcinoma. Increasing the number of cassettes by two and eight cassettes, respectively, resulted in a detection rate of 100% in both cohorts without revealing high-grade carcinomas. Subgroup analyses in HoLEP patients confirmed these findings, demonstrated by a 100 vs. 96% iPCa detection rate following examination of the first ten cassettes, missing one case of T1a/ISUP 1. Examination of 8 additional cassettes resulted in a 100% detection rate. The extent of embedding of material obtained from transurethral prostate resection correlates with the iPCa detection rate. However, the submission of 10 cassettes appears to be a reasonable threshold to reduce resource utilization while maintaining secure cancer detection.

• Authors: Jens Köllermann, Benedikt Hoeh, Daniel Ruppel, Kevin Smith, Henning Reis, Mike Wenzel, Felix Preisser, Marina Kosiba, Philipp Mandel, Pierre I Karakiewicz, Andreas Becker, Felix K H Chun, Peter Wild, Luis A Kluth
• Journal: Virchows Archiv : an international journal of pathology (Virchows Arch) Vol. 481 Issue 3 Pg. 387-396 (Sep 2022) ISSN: 1432-2307 [Electronic] Germany
• PMID: 35710851 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Chemical References

• Yttrium
• Aluminum
• Holmium

Topics

• Aluminum
• Carcinoma (pathology)
• Holmium
• Humans
• Laser Therapy (methods)
• Male
• Prostate (pathology)
• Prostatic Hyperplasia (diagnosis, pathology, surgery)
• Prostatic Neoplasms (diagnosis, pathology, surgery)
• Tissue Embedding
• Transurethral Resection of Prostate (methods)
• Treatment Outcome
• Urinary Bladder Neck Obstruction (pathology, surgery)
• Yttrium