PURPOSE: To evaluate the clinical significance of intra-operative ureteral frozen section analysis (FSA) at the time of radical cystectomy. MATERIALS AND METHODS: A total of 402 patients underwent radical cystectomy for urothelial carcinoma of the bladder at our institution from January 1991 to December 2011. Except for 35 ureters who underwent nephroureterectomy, 769 ureters were finally identified. Among these, FSA was performed at 645 ureters (83.8 %). If the first FSA result was positive for malignancy (carcinoma in situ or carcinoma) or demonstrated atypia or dysplasia, sequential ureteral resection was undertaken until normal urothelium was identified, when possible. RESULTS: A total of 54 ureters (8.4 %) of 46 patients (11.2 %) had ureteral involvement (positive) on the first FSA. On permanent section analysis (PSA), ureteral involvement was noted in 40 ureters (6.2 %) of 35 patients (8.7 %). The sensitivity, specificity, and accuracy of FSA were approximately 75, 96, and 95 %, respectively. Intramural tumor invasion was correlated with ureteral involvement on both FSA and PSA (p < 0.05). There was no correlation between upper urinary tract (UUT) recurrence and ureteral involvement on FSA and PSA. Positive FSA and PSA were not risk factors associated with overall and cancer-specific survival (CSS) on multivariate analysis. CONCLUSIONS: Intra-operative FSA can reasonably detect ureteral involvement. However, a relatively high false-positive rate (44 %) may be problematic and has the likelihood to overestimate disease at the ureteral margin. Overall, routine FSA of the ureters shows no correlation with UUT recurrence as well as overall and CSS.
PURPOSE: To evaluate the clinical significance of intra-operative ureteral frozen section analysis (FSA) at the time of radical cystectomy. MATERIALS AND METHODS: A total of 402 patients underwent radical cystectomy for urothelial carcinoma of the bladder at our institution from January 1991 to December 2011. Except for 35 ureters who underwent nephroureterectomy, 769 ureters were finally identified. Among these, FSA was performed at 645 ureters (83.8 %). If the first FSA result was positive for malignancy (carcinoma in situ or carcinoma) or demonstrated atypia or dysplasia, sequential ureteral resection was undertaken until normal urothelium was identified, when possible. RESULTS: A total of 54 ureters (8.4 %) of 46 patients (11.2 %) had ureteral involvement (positive) on the first FSA. On permanent section analysis (PSA), ureteral involvement was noted in 40 ureters (6.2 %) of 35 patients (8.7 %). The sensitivity, specificity, and accuracy of FSA were approximately 75, 96, and 95 %, respectively. Intramural tumor invasion was correlated with ureteral involvement on both FSA and PSA (p < 0.05). There was no correlation between upper urinary tract (UUT) recurrence and ureteral involvement on FSA and PSA. Positive FSA and PSA were not risk factors associated with overall and cancer-specific survival (CSS) on multivariate analysis. CONCLUSIONS: Intra-operative FSA can reasonably detect ureteral involvement. However, a relatively high false-positive rate (44 %) may be problematic and has the likelihood to overestimate disease at the ureteral margin. Overall, routine FSA of the ureters shows no correlation with UUT recurrence as well as overall and CSS.
Authors: Ganesh V Raj; Raanan Tal; Andrew Vickers; Bernard H Bochner; Angel Serio; S Machele Donat; Harry Herr; Semra Olgac; Guido Dalbagni Journal: Cancer Date: 2006-11-01 Impact factor: 6.860
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Authors: Francesco Claps; Maaike W van de Kamp; Roman Mayr; Peter J Bostrom; Joost L Boormans; Markus Eckstein; Laura S Mertens; Egbert R Boevé; Yann Neuzillet; Maximilian Burger; Damien Pouessel; Carlo Trombetta; Bernd Wullich; Theo H van der Kwast; Arndt Hartmann; Yves Allory; Yair Lotan; Shahrokh F Shariat; Tahlita C M Zuiverloon; M Carmen Mir; Bas W G van Rhijn Journal: World J Urol Date: 2021-07-01 Impact factor: 4.226