Diagnosis of micrometastasis in muscle invasive bladder cancer through immunohistochemistry analysis: is there indication for routine evaluation?

Gustavo Cuck,
Isabela Werneck da CunhaEmail author View ORCID ID profile,
Walter Henriques da CostaEmail author,
Clóvis Antônio Lopes Pinto,
Carlos Alberto Ricetto Sacomani,
Francisco Paulo da Fonseca and
Gustavo Cardoso Guimarães

Applied Cancer Research201636:6

DOI: 10.1186/s41241-016-0005-5

Received: 8 July 2016

Accepted: 15 November 2016

Published: 15 December 2016

Abstract

Background

Muscle invasive bladder cancer (BC) has a mortality rate of 50% in 5 years, despite the aggressive treatments currently used. The diagnosis of latent tumor cells in histologically normal lymph nodes (LN) may have prognostic value and may explain the tumoral recurrence in BC.

Methods

Here we evaluated the use of the AE1AE3 cytokeratin marker through immunohistochemical examination of LNs to diagnose micrometastasis in patients with BC undergoing radical cystectomy (RC) and lymph node dissection. Sixty-one patients with pN0 diseases who were submitted to RC were studied. Conventional histological evaluation indicated that these patients did not have lymph node metastasis. Histological sections were reviewed and analyzed by immunohistochemistry (IHC) using the AE1AE3 antibody in single sections.

Results

The total number of removed LNs was 832, averaging 13.64 LNs per patient. The IHC evaluation revealed that LN from 2/61 (3.27%) patients had micrometastasis. At the time of the last follow-up, 41% of all patients were in complete disease remission and 41.1% had died from BC.

Conclusions

Our study shows that histological analysis using hematoxylin eosin (HE) method by experienced pathologists is sufficient for the diagnosis of LN metastasis and, therefore, there is no indication for routine IHC evaluation in patients at histopathological pN0 stage.