Role of Frozen Section Analysis during Radical Prostatectomy: A 1,993-Case Experience
Yasuhiro Kakiuchi, Jennifer Gordetsky, Hiroshi Miyamoto. University of Rochester, Rochester, NY
Background: It remains unanswered whether intraoperative frozen section analysis (FSA) contributes to surgical margin (SM) status on radical prostatectomy (RP) specimens.
Design: We retrospectively studied a consecutive series of patients who underwent robotic-assisted laparoscopic RP performed at our institution between 2006 and 2001. From our surgical pathology electronic database, we identified 1993 cases coded as RP specimens, including 913 (45.8%) cases in which FSA was done for assessing the areas suspicious for positive SMs (+SMs).
Results: FSAs were reported as positive (n=49; 5.4 %), negative (n=827; 90.6%), and atypical (n=37; 4.0%), respectively. Of the 49 cases with positive FSA, 25 (51.0%) were found to have +SMs on RP specimens while others showed either negative SMs (n=21; 42.9%) or indeterminate for margin status (n=3; 6.1%). On the other hand, among the cases with negative and atypical FSAs, 103 (12.5%) and 8 (21.6%) were +SMs on RP specimens, respectively. Thus, the rate of +SMs on RP was significantly higher in positive FSA cases than in negative (P<0.001) or atypical (P=0.005) FSA. Nonetheless, FSA failed to predict +SMs in 103 (12.5%) of 827 cases where negative FSAs were reported. Overall, 136 (14.9%) of 913 cases with FSA had +SMs, compared with 135 (12.5%) of 1080 cases with no FSA (P=0.068). The sensitivity, specificity, and positive and negative predictive values of FSA to identify +SMs on RP were 19.5%, 97.2%, 54.3%, and 87.5%, respectively.
Conclusions: Although the specificity and negative predictive value of FSA for isolating +SMs are high, the sensitivity and positive predictive value appear to be too low to anticipate that intraoperative FSA will reduce the incidence of +SMs substantially. Thus, our study suggests questionable utility of FSA during RP. However, further analyses, including those in clinicopathologic features of our cases, are required prior to concluding the importance of intraoperative FSA in RP.
Category: Genitourinary (including renal tumors)
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 115, Tuesday Afternoon