Laparoscopic radical prostatectomy: the value of intraoperative frozen sections.
OBJECTIVE
To examine the clinical and pathological value of intraoperative frozen section (IFS) in patients undergoing laparoscopic radical prostatectomy (L-RPE) for clinically localized prostate cancer.


METHODS
The study includes 198 consecutive cases of L-RPE. After removal of the prostate, a 2-3mm circumferential specimen was obtained from the apical and bladder neck soft-tissue margin and submitted for IFS examination. In cases suspicious for capsular incision (n=57), IFS were taken from the neurovascular bundle/lateral pedicle.


RESULTS
The IFS diagnosis from the apical, bladder neck, and neurovascular bundle/lateral pedicle soft-tissue margins was adenocarcinoma in 12 (6%), 1 (0.5%), and 2 (1%) cases, respectively. Patient age, clinical stage, and mean specimen weight were not associated with cancer at the apical IFS. The accuracy, sensitivity, specificity, positive and negative predictive value of the apical IFS to predict cancer in the permanent section of the apical soft-tissue margin was 96%, 70%, 97%, 58%, and 98%, respectively. All the patients (n=15) with cancer at IFS had wide resections of additional tissue in the area of positive soft-tissue margin and all had no cancer in the additional resected tissue. Especially at the apex, IFS decreases the overall PSM status on surgical specimen by 5.1% (apical PSM from 8.6% to 3.5%).


CONCLUSIONS
Because of the low predictive value of IFS of bladder neck and neurovascular bundle/lateral pedicle their use is not recommended. IFS of the apex should be performed to reduce the PSM rate.
Dillenburg
Wolfgang
W
Department of Urology, Northwest Hospital, Stiftung Hospital zum Heiligen Geist, Steinbacher Hohl 2-26, D-60488 Frankfurt/Main, Germany. ebm_urology@gmx.de
Poulakis
Vasileios
V
Witzsch
Ulrich
U
de Vries
Rachelle
R
Skriapas
Konstantinos
K
Altmansberger
Hans-Michael
HM
Becht
Eduard
E
D000230:Adenocarcinoma / Q000097:blood / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D005500:Follow-Up Studies; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D047368:Tumor Burden
D017430:Prostate-Specific Antigen