Lymph node expression of cytokeratin 7 and 20 in extended lymph node dissection with radical cystectomy for muscle-invasive disease: value in pathologic staging, treatment strategies, and outcomes

Riad, Amr E.; Abd-El-Hafeez, Ismail O.; Kamal, Khaled M.; El-Ganzoury, Hossam M.; Hammam, Olfat A.; Mongiat-Artus, Pierre; Verine, Jerom

doi:10.4103/ejs.ejs_30_20

Lymph node expression of cytokeratin 7 and 20 in extended lymph node dissection with radical cystectomy for muscle-invasive disease: value in pathologic staging, treatment strategies, and outcomes

Authors

Abstract

Background
Precise staging of lymph node (LN) status is an important clinicopathological prognostic parameter following radical cystectomy.
Aim
The aim was to assess tumor recurrence in patients with T2 transitional cell carcinoma undergoing radical cystectomy with extended pelvic lymphadenectomy.
Patients and methods
A total of 80 patients underwent bilateral extended lymphadenectomy during radical cystectomy that reached up to the aortic bifurcation and sentinal LN. This was a multicenter study among Urology Departments of Ain Shams University Hospital, Theodor Bilharz Research Institute, and Saint Louis University Hospital. Comparison was based on classification of patients into two groups: cytokeratin 7 and 20 (CK7 and CK20) positive and negative.
Results
In this study, the authors used both CK7 and CK20 for evaluating the metastatic and micrometastatic burdens in LNs, and these markers were correlated with the primary bladder and its nodal metastases. After displaying the results, we evaluated the markers as follows: CK7 sensitivity is 100%, whereas specificity is 65% and showed 48.8% positive predictive value and 100% negative predictive value, with overall accuracy of 73.8%. CK20 has a sensitivity of 100%, whereas specificity is 65% and showed 48.8% positive predictive value and 100% negative predictive value, with overall accuracy of 73.8%.
Conclusion
The use of molecular markers provides a better and proper nodal staging but what is thought to be a disadvantage is the exaggerated sensitivity sometimes gives false-positive results.

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