Pathologists’ assistants, an essential healthcare workforce: the experience of a surgical pathology department in Italy

2021 ◽  
pp. jclinpath-2021-207430
Author(s):  
Mara Bortesi ◽  
Marialisa Marchetti ◽  
Ilaria Arpaia ◽  
Letizia Marchi ◽  
Marilena Ganassi ◽  
...  
Keyword(s):  
Lymph Node ◽  
Professional Role ◽  
Progressive Increase ◽  
Time Saving ◽  
Retrieval Rate ◽  
Healthcare Workforce ◽  
Lymph Node Retrieval ◽  
Minor Part ◽  
Laboratory Procedures ◽  
Colorectal Resections

AimsThe progressive increase of both the workload and the complexity of laboratory procedures, along with shortage of staff, has made evident the need to increase the efficiency in the pathology departments. To support the pathologists, a new technical professional role, the pathologists’ assistant (PA), has been introduced.MethodsWe decided to carry out a retrospective analysis on PAs’ performance. This was compared with that of junior/senior pathologists in the amount and type of surgical specimens examined, the number of lymph node retrieved in colorectal resections, the number of cases needing a second grossing procedure and the average time spent in grossing. As the COVID-19 pandemic period in fact resulted in a dramatic reduction of histological cases in our department, we divided PA activities into two periods, according to the COVID-19 pandemic.Results‘Simple’ specimens made up the majority (92%) of the specimens examined by PAs in pre-COVID-19 period while ‘complex’ specimens, often neoplastic, represented the minor part (7%). However, ‘simple’ specimens dropped to 81% and ‘complex’ specimens rose to 18% in the COVID-19 period, when PAs had the chance to test themselves with more complicated surgical samples, under the supervision of a pathologist. Lymph node retrieval rate and average time spent in grossing are in line with literature data and confirm that PAs performance is comparable with pathologists’ one, in selected settings.ConclusionIn our experience, PA has represented a fundamental time-saving resource for the pathologists, who can devote time almost exclusively to diagnostic reporting.

scholarly journals Lymph node retrieval rates in melanoma: a quality assessment parameter

2017 ◽  
Vol 24 (4) ◽  
pp. 323 ◽  
Author(s):  
D. Berger-Richardson ◽  
E. Cordeiro ◽  
M. Ernjakovic ◽  
A.M. Easson
Keyword(s):  
Lymph Node ◽  
Quality Assessment ◽  
Regional Lymph Node ◽  
Positive Sentinel Lymph Node ◽  
Nodal Metastasis ◽  
Lymph Node Biopsy ◽  
Retrieval Rate ◽  
Regional Lymph Node Dissection ◽  
Lymph Node Retrieval ◽  
Definition Of

Regional lymph node dissection (RLND) for melanoma with nodal metastases is a specialized procedure that is associated with improved disease-specific survival in select patients. Furthermore, there is evidence that a higher lymph node retrieval rate (LNRR) is associated with improved survival. Currently, there is no consensus on the definition of an adequate LNRR. A minimum LNRR has been proposed as a quality assessment parameter that needs to be validated.Introduction Regional lymph node dissection (rlnd) for melanoma with nodal metastasis is a specialized procedure that is associated with improved disease-specific survival in selected patients. Furthermore, there is evidence that a higher lymph node retrieval rate (lnrr) is associated with improved local control. Currently, no consensus has been reached on the definition of an adequate lnrr. A minimum lnrr has been proposed as a quality assessment parameter that has to be validated.Methods We conducted a retrospective cohort analysis at the Princess Margaret Cancer Centre (University Health Network, Toronto, ON). The lnrrs for all patients who underwent rlnd for malignant cutaneous melanoma during 2000–2010 were recorded. Indications for rlnd were a positive sentinel lymph node biopsy or clinical lymphadenopathy (palpable or radiologically detected).Results Of the 207 identified rlnds, 146 (70.5%) were subsequent to a positive sentinel lymph node biopsy, and 61 (29.5%) were performed for clinical lymphadenopathy. The median lnrr was 24 nodes (range: 9–47 nodes; 10th percentile: 14 nodes) for axillary rlnd, 12 nodes (range: 5–30 nodes; 10th percentile: 8 nodes) for inguinal rlnd, and 16 nodes (range: 10–21 nodes; 10th percentile: 11 nodes) for ilioinguinal rlnd. The results were similar when comparing patients with positive sentinel lymph nodes and those with clinical lymphadenopathy, and the same surgical techniques were used in both groups.Conclusions The lnrrs at our institution are similar to rates reported at other tertiary-care melanoma centres. A minimum acceptable lnrr can be considered a quality assessment parameter in the surgical management of melanoma with nodal metastasis.

Fat clearance of upper gastrointestinal resection specimens increases lymph node yield and may result in nodal upstaging

2018 ◽  
Vol 72 (1) ◽  
pp. 86-89
Author(s):  
Jon Griffin ◽  
Clare Bunning ◽  
Asha Dubé
Keyword(s):  
Lymph Node ◽  
Gastrointestinal Cancers ◽  
Historical Cohort ◽  
Lymph Node Yield ◽  
Patient Demographics ◽  
Lymph Node Retrieval ◽  
Nodal Upstaging ◽  
The Impact ◽  
Upper Gastrointestinal ◽  
Node Yield

IntroductionLymph node retrieval and quantification is an important element in staging upper gastrointestinal cancers. Our department introduced fat clearance for oesophagectomy and gastrectomy specimens in 2014. This study assessed the impact of this change on lymph node yield and upstaging.MethodsWe reviewed histopathology data for upper gastrointestinal resection specimens. Patient demographics, clinical, macroscopic and microscopic data were compared with a historical cohort who did not undergo fat clearance.ResultsOf 158 patients, 133 resection specimens received fat clearance resulting in a significantly higher lymph node yield than the historical cohort (22 vs 13 lymph nodes, p<0.0001). Fat clearance found additional positive nodes in 24.1% of patients and increased the number of cases achieving a minimum node yield of 15. Nodes found by fat clearance caused upstaging in 15% of the cohort.DiscussionFat clearance increases node yield in upper gastrointestinal resection specimens and may cause nodal upstaging.

scholarly journals Clinicopathological Factors Influencing Lymph Node Yield in Colorectal Cancer: A Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Elena Orsenigo ◽  
Giulia Gasparini ◽  
Michele Carlucci
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Rank Test ◽  
Lymph Node Yield ◽  
Log Rank Test ◽  
Lymph Node Retrieval

Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the adequate nodal yield in colorectal specimens subject to routine pathological assessment. We have retrospectively analysed the data of 2319 curatively resected colorectal cancer patients in San Raffaele Scientific Institute, Milan, between 1993 and 2017 (1259 colon cancer patients and 675 rectal cancer patients plus 385 rectal cancer patients who underwent neoadjuvant therapy). The factors influencing lymph node retrieval were subjected to uni- and multivariate analyses. Moreover, a survival analysis was carried out to verify the prognostic implications of nodal counts. The mean number of evaluated nodes was 24.08±11.4, 20.34±11.8, and 15.33±9.64 in surgically treated right-sided colon cancer, left-sided colon cancer, and rectal tumors, respectively. More than 12 lymph nodes were reported in surgical specimens in 1094 (86.9%) cases in the colon cohort and in 425 (63%) cases in the rectal cohort, and patients who underwent neoadjuvant chemoradiation were analysed separately. On univariate analysis of the colon cancer group, higher LNs counts were associated with female sex, right colon cancer, emergency surgery, pT3-T4 diseases, higher tumor size, and resected specimen length. On multivariate analysis right colon tumors, larger mean size of tumor, length of specimen, pT3-T4 disease, and female sex were found to significantly affect lymph node retrieval. Colon cancer patients with 12 or more lymph nodes removed had a significantly better long-term survival than those with 11 or fewer nodes (P=0.002, log-rank test). Rectal cancer patients with 12 or more lymph nodes removed approached but did not reach a statistically different survival (P=0.055, log-rank test). Multiple tumor and patients’ factors are associated with lymph node yield, but only the removal of at least 12 lymph nodes will reliably determine lymph node status.

Comparison of Standard Distal Pancreatectomy and Splenectomy with Radical Antegrade Modular Pancreatosplenectomy

2014 ◽  
Vol 80 (3) ◽  
pp. 295-300 ◽  
Author(s):  
Paul Trottman ◽  
Katrina Swett ◽  
Perry Shen ◽  
Joseph Sirintrapun
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Distal Pancreatectomy ◽  
Tumor Staging ◽  
The Body ◽  
Lymph Node Count ◽  
Standard Resection ◽  
Lymph Node Retrieval ◽  
Significant Difference ◽  
Radical Antegrade Modular Pancreatosplenectomy

Radical antegrade modular pancreatosplenectomy (RAMPS) has been reported to provide improved margin resection and lymph node retrieval for tumors of the body and tail of the pancreas compared with standard resection. We examined our experience with RAMPS and standard resection to determine differences in clinicopathologic outcomes. A comparison of RAMPS procedures was made to standard distal pancreatectomy and splenectomy examining various clinicopathologic variables through retrospective chart review. Twenty-six patients underwent distal pancreatectomy with or without splenectomy between November 2004 and June 2011. Twenty patients underwent standard resection and six patients underwent RAMPS procedures for a variety of histologies. As a result of the heterogeneity of diseases, which included benign lesions, margin status was not applicable in some cases and therefore was not assessed overall. Fisher's exact test and Wilcoxon rank sum tests demonstrated a significant difference in number of lymph nodes removed with mean of 4.3 and 11.2 lymph nodes obtained for standard resection and RAMPS, respectively ( P = 0.03). The RAMPS procedure for lesions of the body and tail of the pancreas retrieved significantly more lymph nodes than standard distal pancreatectomy and splenectomy. It should be the preferred surgical approach when lymph node count is important for tumor staging.

scholarly journals The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

2020 ◽  
Vol 72 (3) ◽  
pp. 793-800 ◽  
Author(s):  
Giovanni Li Destri ◽  
Andrea Maugeri ◽  
Alice Ramistella ◽  
Gaetano La Greca ◽  
Pietro Conti ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Prognostic Impact ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Lymph Node Retrieval

Abstract According to the American Joint Committee on Cancer, at least 12 lymph nodes are required to accurately stage locally advanced rectal cancer (LARC). Neoadjuvant chemoradiation therapy (NACRT) reduces the number of lymph nodes retrieved during surgery. In this study, we evaluated the effect of NACRT on lymph node retrieval and prognosis in patients with LARC. We performed an observational study of 142 patients with LARC. Although our analysis was retrospective, data were collected prospectively. Half the patients were treated with NACRT and total mesorectal excision (TME) and the other half underwent TME only. The number of lymph nodes retrieved and the number of metastatic lymph nodes were significantly reduced in the NACRT group (P > 0.001). In the univariate and multivariate analyses, only NACRT and patient age were significantly associated with reduced lymph node retrieval. The number of metastatic lymph nodes and the lymph node ratio (LNR) both had a significant effect on prognosis when the patient population was examined as a whole (P = 0.003 and P = 0.001, respectively). However, the LNR was the only significant, independent prognostic factor in both treatment groups (P = 0.007 for the NACRT group; P = 0.04 for the no-NACRT group). NACRT improves patient prognosis only when the number of metastatic lymph nodes is reduced. The number of metastatic lymph nodes and the LNR are important prognostic factors. Lymph node retrieval remains an indispensable tool for staging and prognostic assessment of patients with rectal carcinoma treated with NACRT.

Does obesity impact lymph node retrieval in colon cancer surgery?

2010 ◽  
Vol 200 (4) ◽  
pp. 478-482 ◽  
Author(s):  
Jared H. Linebarger ◽  
Michelle A. Mathiason ◽  
Kara J. Kallies ◽  
Stephen B. Shapiro
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Cancer Surgery ◽  
Lymph Node Retrieval ◽  
Colon Cancer Surgery
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