Removal of the bladder (cystectomy with lymphadenectomy) (PG041)

Pathomorphological examination in cystectomy with lymphadenectomy — is a large-scale histological study of the entire removed bladder along with surrounding tissue and regional lymph nodes. Code PG041 corresponds to a complex analysis of the surgical material, which is the final stage of diagnosing bladder cancer and determines the further tactics of oncological treatment.

Research objective: The main task is to accurately stage the disease according to the international TNM system. The pathologist must confirm the radicality of the operation (the absence of tumor at the edges of the resection) and find out whether the cancer has spread to the lymph nodes or neighboring organs (prostate in men, uterus in women).

What does the pathologist evaluate:

• Depth of invasion (stage T): how deeply the tumor has grown into the muscle layer or has extended beyond the bladder wall into the paravesical tissue.

• Lymph node status (stage N): examination of each removed node for the presence of metastases (this is a key prognostic factor).

• Resection margins (R0/R1): checking the ureters and urethra for the absence of tumor cells at the cut site.

• Histological type and differentiation: confirmation of the type of cancer (most often transitional cell) and the degree of its aggressiveness.

• Associated pathologies: detection of carcinoma in situ (CIS) in areas that visually appeared healthy.

Clinical significance: The conclusion with the code PG041 is the basis for making a decision on the need for further adjuvant (postoperative) chemotherapy or radiotherapy. Accurate determination of the number of affected lymph nodes and the depth of tumor growth allows the oncologist to predict the risk of recurrence and draw up an individual patient monitoring schedule.

When is it prescribed:

• after radical cystectomy for muscle-invasive bladder cancer;

• for recurrent high-grade cancer that is not amenable to endoscopic treatment;

• when the bladder tumor spreads to neighboring organs of the abdominal cavity and pelvis.