Artikel
The accuracy of sequential urethral frozen sections and its impact on urethral recurrence after radical cystectomy
Suche in Medline nach
Autoren
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Tina Schubert
- Uniklinik Würzburg
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Fahmy Hassan
- Uniklinik Würzburg
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Manuel Alexander Schmid
- Uniklinik Würzburg
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Markus Renninger
- Uniklinik Würzburg
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Arnulf Stenzl
- Uniklinik Würzburg
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Hubert Kübler
- Uniklinik Würzburg
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Georgios Gakis
- Uniklinik Würzburg
| Veröffentlicht: | 17. Mai 2018 |
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Gliederung
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Background: Our objective was to determine the accuracy of frozen section analysis (FSA) for detecting and eliminating malignant urethral margins during radical cystectomy (RC) for bladder cancer (BC) and its impact on urethral recurrence.
Methods: Urethral margins were initially examined by FSA in 217 patients treated with RC. When positive, additional resections were performed. Subsequently, all specimens were reexamined on formalin-fixed, paraffin-embedded sections (FFPE). Malignancy was defined as either the presence of carcinoma in situ, high-grade or invasive tumor cells at the margin. Fisher Exact/Chi-square test was used for univariable analysis and Kaplan-Meier analysis with log-rank test to assess the impact of final urethral margin status on urethral recurrence.
Results: At initial examination, malignant urethral margins were found to be positive on FSA in 21 patients, on FFPE in 17 (sensitivity: 88.2%; specificity: 97.0%; positive predictive value (PPV): 71.4%; negative predictive value (NPV): 99.0%; overall accuracy 96.3%). After initial frozen section, a total of 23 patients were subjected to intraoperative re-resections (median: 1, mean: 1.1 total range: 1-3). None of the 10 (43.5%) patients with a positive final urethral frozen section on re-resection was found to be positive on FFPE. The overall accuracy of urethral frozen sections after sequential resection was 52.2%. The corresponding 3-year urethral recurrence-free survival was 99.1% for patients with negative final margins on initial assessment (I), 100% for those with negative final margins after re-resection (II) and 83.3% for all patients (III) with positive margins on FFPE (p=0.013; for I+II vs. III).
Conclusions: The accuracy of FSA for detecting malignant urethral margins is high on initial examination but drops considerably in case of re-resection. Yet, most positive urethral margins on initial FSA are converted into negatives ones after re-resection. Conversion of a positive into a negative margin is associated with a lower risk of urethral recurrence.
