Intraoperative Frozen Section Evaluation of Ureteral and Urethral Margins: Studies of 212 Consecutive Radical Cystoprostatectomies for Men with Bladder Urothelial Carcinoma
Haijun Zhou, Jae Y Ro, Luan D Truong, Alberto G Ayala, Steven S Shen. The Methodist Hospital, Weill Medical College of Cornell University, Houston, TX
Background: Radical cystoprostatectomy with pelvic lymph nodal dissection is the standard procedure for men with invasive bladder cancer or non-invasive cancer that is resistant to intravesical therapy. Intraoperative frozen section is frequently used to guide the extent of surgery. However, it is still controversial whether intraoperative frozen sections of ureteral and urethral margins are necessary for all patients or a risk-based assessment is the best approach.
Design: A total of 212 men with bladder urothelial carcinoma treated by radical cystoprostatectomy with nodal dissection from 2003 to 2010 in our institution were reviewed. Clinicopathologic features studied include: patients' age, pathologic tumor stage, presence of carcinoma in- situ (CIS), and intraoperative frozen section diagnosis.
Results: The average age of patients in this series was 67.1 years (range 39.2 to 89.1). Tumor stage percentage distribution was as follows: pT0 (7.1%), pTis and pTa (20.3%), pT1 (10.9%), pT2 (19.8%), pT3 (35.4%) and pT4 (4.7%), pTx (1.9%). Among 212 patients, 203 had intraoperative frozen section of ureters, of which 17 (8.4%) had positive margin for CIS (16 cases) or invasive urothelial carcinoma (1 case). Logistic regression analysis showed that positive ureteral margin was not associated with patients' age or tumor stage, but was significantly associated with the presence of CIS in the bladder (p<0.001). In bladder cancer patients (n=110) who had concomitant CIS, 17 patients (15.5%) had positive frozen ureteral margin, in contrast, none of the patients (n=93) had positive frozen ureteral margin when they did not have concomitant CIS. In 37 patients who had urethral frozen sections, 3 patients (8.1%) had positive margin and all of them had concomitant CIS in the bladder.
Conclusions: Our study showed that the rates of positive ureteral and urethral margins during intraoperative frozen section are 8.4% and 8.1% respectively. The presence of concomitant CIS in patient with bladder cancer is highly associated with positive ureteral and urethral margins; therefore, intraoperative frozen section may be helpful in these patients. On the other hand, in patients without concomitant CIS, frozen section of ureteral margin is probably unnecessary.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 155, Monday Morning