Christian Daniel Fankhauser1, Lisa Roth2, Benedikt Kranzbühler2, Daniel Eberli2, Peter Bode3, Holger Moch3, Pedro Oliveira4, Vijay Ramani5, Joerg Beyer6, Thomas Hermanns2. 1. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK. Electronic address: christian.fankhauser@usz.ch. 2. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 3. Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 4. Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK. 5. Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK. 6. University Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Abstract
For inconclusive testicular tumors with negative tumor markers, frozen section examination (FSE) during inguinal exploration is recommended. However, FSE is time-consuming and therefore often not requested. Furthermore, the exact diagnostic benefit remains poorly defined. We performed a systematic review and meta-analysis summarizing 12 published studies and our own series of FSE in patients with inconclusive testicular tumors, resulting in a cohort of 1052 FSEs. FSE showed sensitivity of 99% and specificity of 96% with a positive predictive value of 98% and a negative predictive value of 97%. Most importantly, one-third of all testicular tumors investigated were correctly identified as being suitable for testis-sparing surgery and orchiectomy could be avoided. For patients with inconclusive testicular tumors, FSE is useful for deciding whether testis-sparing surgery is an option or whether radical orchiectomy should be performed. Thus, these patients should be optimally treated in institutions where FSE is available. PATIENT SUMMARY: We found that intraoperative examination of a frozen section is useful in deciding on whether the entire or only parts of the testicle can be removed. We conclude that frozen section examination should be offered to men with small testicular lesions and negative tumor markers.
For inconclusive testicular tumors with negative tumor markers, frozen section examination (FSE) during inguinal exploration is recommended. However, FSE is time-consuming and therefore often not requested. Furthermore, the exact diagnostic benefit remains poorly defined. We performed a systematic review and meta-analysis summarizing 12 published studies and our own series of FSE in patients with inconclusive testicular tumors, resulting in a cohort of 1052 FSEs. FSE showed sensitivity of 99% and specificity of 96% with a positive predictive value of 98% and a negative predictive value of 97%. Most importantly, one-third of all testicular tumors investigated were correctly identified as being suitable for testis-sparing surgery and orchiectomy could be avoided. For patients with inconclusive testicular tumors, FSE is useful for deciding whether testis-sparing surgery is an option or whether radical orchiectomy should be performed. Thus, these patients should be optimally treated in institutions where FSE is available. PATIENT SUMMARY: We found that intraoperative examination of a frozen section is useful in deciding on whether the entire or only parts of the testicle can be removed. We conclude that frozen section examination should be offered to men with small testicular lesions and negative tumor markers.
Authors: Athina C Tsili; Nikolaos Sofikitis; Ourania Pappa; Christina K Bougia; Maria I Argyropoulou Journal: Cancers (Basel) Date: 2022-08-13 Impact factor: 6.575