Role of intraoperative biopsies during radical retropubic prostatectomy.
OBJECTIVE
To determine the value of intraoperative biopsy during radical retropubic prostatectomy.


METHODS
Between October 2000 and August 2002, 500 men with clinically localized prostate cancer underwent radical retropubic prostatectomy by a single surgeon. A 2 to 3-mm circumferential biopsy was routinely obtained from the apical and bladder neck soft-tissue margin and submitted for frozen section examination. In selective cases suspicious for capsular incision, a biopsy was sent from what was believed to be the contiguous neurovascular bundle/lateral pedicle.


RESULTS
Prostate cancer was observed in 4.5%, 0.8%, and 1.6% of the intraoperative biopsies sent from the apical, bladder neck, and neurovascular bundle/lateral pedicle soft-tissue margins, respectively. Patient age, Gleason score, perineural invasion on diagnostic prostate biopsy, and clinical stage were not associated with prostate cancer at the apical soft-tissue margin. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the surgical specimen to predict cancer in the apical soft-tissue margin was 57.7%, 98.2%, 62%, 97.7%, and 96%, respectively. Intraoperative biopsy of the apical soft-tissue margin reduced the positive margin rate by 3.8%.


CONCLUSIONS
The yield of intraoperative biopsy of the bladder neck and neurovascular bundle/lateral pedicle is too low to justify it in routine practice. Biopsy of the apical soft tissue should be routinely performed to reduce the positive surgical margin rate.
Lepor
Herbert
H
Department of Urology, New York University School of Medicine, New York, New York 10016, USA.
Kaci
Ledia
L
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D001706:Biopsy / Q000379:methods; D005500:Follow-Up Studies; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D010525:Peripheral Nerves / Q000473:pathology; D011237:Predictive Value of Tests; D011467:Prostate / Q000294:innervation; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014521:Urethra / Q000473:pathology