PURPOSE: To evaluate whether intraoperative frozen section analysis (FS) of the prostate surface might provide significant information ensuring nerve-sparing and minimizing positive margin rates.
MATERIAL AND METHODS: Between 6/2011 and 9/2012, 236 patients treated with radical prostatectomy received intraoperative whole surface FS analysis of the removed prostate. The apex and base were circumferencially dissected as well as the whole posterolateral tissue corresponding to the neurovascular bundles (NVB). Multiple perpendicular sections were cut systematically for FS analysis. Pathology results were reported to navigate the procedure.
RESULTS: FS analysis identified positive surgical margins (PSM) in 22% (NVB: 56.9%, apex 34.5%, base: 8.6%). Of men with a positive FS, 92.3% could be converted to a negative status, while 7.7% remained positive. Final positive margin status of the total cohort was 3% including a false negative FS rate of 1.6%. In 14.8% the initial nerve-sparing plan was intraoperatively changed due to positive FS. Secondary resected specimen detected cancer in 25%. Final pathology showed Gleason upgrading or upstaging in 40.7% compared to preoperative variables. Comparing the group of patients with positive versus negative FS, preoperative variables were not significantly different while postoperatively pathologic stage, tumor volume, length of surgery and final margin status were. 13% of patients who had exclusively unilateral positive biopsies showed a PSM intraoperatively on the opposite, biopsy negative, site.
CONCLUSIONS: Surface frozen section technique is associated with a low false negative surgical margin rate and might allow safer preservation of functional anatomic structures in misclassified patients or even patients at higher preoperative risk.
Written by:
von Bodman C, Brock M, Roghmann F, Byers A, Löppenberg B, Braun K, Pastor J, Sommerer F, Noldus J, Palisaar RJ. Are you the author?
Department of Urology, Ruhr-University Bochum, Marienhospital Herne, Widumerstrasse 8, 44627 Herne.
Reference: J Urol. 2013 Feb 12. pii: S0022-5347(13)00278-4.
doi: 10.1016/j.juro.2013.02.011
PubMed Abstract
PMID: 23415965
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