A HALF A NODE OR A WHOLE NODE - A COMPARISON OF METHODS FOR SUBMITTING LYMPH-NODES

For many neoplasms, the status of regional lymph nodes is a critical p rognostic factor with direct therapeutic implications. Despite the imp ortance of lymph node status, there is no consensus on whether lymph n odes from node dissections should be submitted in their entirety. To s tudy this issue, for a 4-month period, all lymph nodes from node disse ctions were submitted in their entirety. The larger nodes were submitt ed systematically to determine whether the additional tissue blocks co ntained metastases that were not identified in the initial tissue bloc k. We also analyzed the cost of submitting, processing, and interpreti ng these extra blocks. During the study period, 149 patients underwent lymph node dissections, yielding a total of 2,915 lymph nodes. Submit ting the larger nodes in their entirety resulted in processing 808 add itional tissue blocks that demonstrated a total of 9 additional metast ases in 7 patients. In 2 of these patients, the additional metastases changed the stage of the neoplasm and may have contributed to an alter ation in therapy. By using median salary figures, the estimated cost f or submitting, processing, and interpreting the additional blocks was $5,935.62. Whether the additional positive nodes justify this cost sho uld be determined by individual pathology practices.