Immunohistological detection of lymph node metastases in the testicular center as quick section diagnosis during retroperitoneal lymphadenectomy.

The object of this study was to determine whether the immunohistochemical detection of cytokeratin (CK)-positive cells is useful as quick section diagnosis, and whether the retroperitoneal lymphadenectomy (RLA) can be reduced by this method without any disadvantage for the patient. The RLA represents a combined diagnostic and therapeutic procedure for staging as well as removal of regional lymph node metastases in patients with malignant testis tumors. The disadvantage of the radical RLA is a 40 to 90% loss of potency. The risk of the reduced RLA is the relapse. The metastatic affection of the first retroperitoneal lymph node station, the so-called "sentinale" lymph nodes, allows a judgement for the remaining lymph nodes, and, therefore, for the extent of the necessary operation. The conventional frozen technique has a limited reliability, whereas the paraffin technique needs too much time. We used the immunohistochemistry as alternative method for the rapid as well as reliable evaluation of metastases. A group (7 cases) of 35 patients with non-seminomatous tumors of the testis was only treated by radical RLA after detection of CK-positive cells in the sentinale lymph nodes. The other patients were treated by modified RLA (20 cases) or reduced RLA (6 cases). The results were compared with a control group (48 cases) which was treated by radical RLA only. Using the modified RLA the relapse-free interval was not affected and the loss of ejaculation as a consequence of radical treatment could be avoided.(ABSTRACT TRUNCATED AT 250 WORDS)