Frozen section examination (FSE) of the tumor resection margins is important during penile-preserving surgery (PPS) in penile cancer. The margin status will impact on how much penile or urethral tissue is excised. We aim to evaluate the outcomes of intraoperative FSE of resection margins in PPS.
A retrospective analysis of patients with penile squamous cell carcinoma (SCC) who underwent a FSE of resection margins between 2010 and 2022 was conducted. FSEs were compared with the final histopathological analysis and the Diagnostic Testing Accuracy (DTA): sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated.
Overall, 137 FSE were performed. The median (IQR) age was 65 (53-75) years. 118 (86.1%) patients had negative FSE margins, 16 (11.7%) had positive FSE margins and 3 (2.2%) had equivocal (atypical cells) results. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of penile FSE were 66.7%, 100%, 100%, 93.2% and 94% respectively. 18 patients underwent further resection in the same episode due to a positive or equivocal FSE and 12 (66.7%) achieved negative margins. Limitations include the retrospective nature of the study and lack of control arm to compare with.
Intraoperative FSE performed at our center for the assessment of penile SCC margins is 66.7% sensitive and 100% specific. FSE should be considered in PPS, as it's an essential and a reliable diagnostic tool in minimizing over-treatment.
Clinical genitourinary cancer. 2024 Aug 06 [Epub ahead of print]
Karl H Pang, Mohammad Yunis, Aiman Haider, Alex Freeman, Paul Hadway, Raj Nigam, Rowland Rees, Asif Muneer, Hussain M Alnajjar
Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK., King's College London Medical School, London, UK., Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK., Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, UK., Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK., Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; Department of Surgical Biotechnology, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK., Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK. Electronic address: .