Objectives: To determine the minimum number of nodes (nmin) that need to be removed to ascertain N₀ status with 90/95% certainty, and to determine the maximum number of nodes theoretically involved for a given number ‘m’ of involved nodes reported out of a total of ‘n’ nodes examined. Methods: 2,025 patients underwent cystectomy and pelvic lymphadenectomy, with pathologic stage ≤pT2 in 1,132 (55.9%) and ≧pT3 in 893 (44.1%). A mathematical model was utilized, using incidences derived from those having ≧10 nodes retrieved. Results: For stage ≤pT2 and 0, 1, or 2 positive nodes reported, nmin are 2, 27, and 28, respectively, for 90% accuracy and 12, 29, and 29, respectively, for 95% accuracy. For stage ≧pT3 and 0, 1, or 2 positive nodes reported, nmin are 19, 28, and 29, respectively, for 90% accuracy and 24, 29, and 30, respectively, for 95% accuracy. Conclusions: Accuracy of the extent of nodal involvement depends on the number of positive nodes reported, total number of nodes retrieved, and pathologic stage. This model allows clinicians to assess potential underestimation of the ‘true’ number of involved nodes for a given number of positive nodes out of a total number reported.

Keywords:
Bladder neoplasms, Lymph nodes, Lymph node excision, Cystectomy
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© 2010 S. Karger AG, Basel
2010
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