Frozen Section (FS) Evaluation of Margins in Radical Prostatectomy Specimens.
Amberly Nunez, Faisal Mukhtar, Virginia Dailey, Rizk El-Galley, Omar Hameed. University of Alabama at Birmingham
Background: Intraoperative consultation during radical prostatectomy is sometimes performed to evaluate for the presence of adenocarcinoma ± benign prostatic glands at surgical margins. However, the utility of routine FS analysis for this indication remains controversial as the literature shows mixed results.
Design: A retrospective search was conducted at our institution to identify all radical prostatectomy cases evaluated by FS over a 5-year period. Excluding those performed for lymph node evaluation, the original FSs and the corresponding permanent sections were reviewed to determine the presence/absence of prostatic adenocarcinoma and benign prostatic glands. Histological review of the remaining sections was used to determine the final margin status of the entire prostate gland.
Results: During the study period, 71/575 (12.3%) cases underwent FS evaluation of margins generating 192 individual FSs (range, 1-10/case; mean, 2.65±0.25). These FSs were labeled as from the bladder neck/base (90), posterolateral/neurovascular bundle (71), apex/distal urethra (20), or seminal vesicles (11). Eight FSs were diagnosed as atypical or suspicious because of significant freezing, crushing and/or thermal artifacts, 11 as positive for carcinoma, and the remaining 173 as benign, including 2 that had carcinomatous glands show up on permanent sections. This resulted in a sensitivity of 85%, specificity of 100%, positive predictive value (PV) of 100%, negative PV of 99% and accuracy of 99%. When the final margin status was considered as the gold standard, the sensitivity dropped to 71%, the negative PV to 87% and the accuracy to 81%. The mean number of FSs in cases with positive final margin(s) was not significantly different from that in cases with negative margins (3.1 vs. 2.5; P=.3). Benign prostatic glands were identified in 50 (27%) FSs, most frequently in those from the bladder neck/base (37/90); 41%) followed by those from the apex/distal urethra (8/20; 40%), seminal vesicle (1/11; 9%) and posterolateral/neurovascular bundle (4/71; 6%).
Conclusions: Evaluation of margins by FS in radical prostatectomy specimens is quite specific for the diagnosis of adenocarcinoma; however, potential histological artifacts and a lower sensitivity, especially for the prediction of final margin status, somewhat limit its diagnostic utility. Accordingly, only judicious use is recommended. Although a significant proportion of FSs harbor benign prostatic glands, the value of additional resection following such a finding in decreasing the risk of biochemical failure is yet to be determined.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:00 PM
Poster Session II # 120, Monday Afternoon