title: Value of frozen section analysis with suspected testicular malignancy.
abstract: OBJECTIVE
  To determine whether frozen section analysis (FSA) assists safe conservative surgery for men presenting with suspected testicular tumors.
  
  
  METHODS
  We performed a retrospective review of intraoperative testicular FSA used at a single university institution during an 11-year period. The exclusion criteria included lesions of paratesticular origin, size greater than 5 cm, and the known presence of elevated tumor markers or metastatic disease.
  
  
  RESULTS
  Eighty men underwent FSA, facilitating the diagnosis of germ cell malignancy in 51 (54.3%) of the 94 new cases encountered during this period. Malignancy was reported by FSA in 52 patients (65.0%), but was later revised in 3 to benign Leydig cell tumor after orchiectomy. Also, 2 of 27 specimens reported as benign by FSA were revised to malignant after analysis of paraffin-embedded tissue from the biopsies. Both were seminoma and required delayed orchiectomy. FSA was reported as "suspicious" (intratubular germ cell neoplasia with necrosis) in 1 patient, in whom orchiectomy was performed and malignancy confirmed. In total, orchiectomy was avoided in 25 cases (31.3%). The positive and negative predictive value for FSA in the diagnosis of testicular malignancy was 94.2% and 92.6%, respectively. Of 13 lesions 1 cm or less, 10 (76.9%) were benign. All 26 lesions greater than 3 cm were malignant. A clear correlation between lesion size and the diagnosis of malignancy was demonstrated.
  
  
  CONCLUSIONS
  FSA is a valuable tool assisting testicular preservation. Lesion size correlated with incidence of malignancy; therefore, FSA may be best used for small testicular lesions suitable for excision biopsy.
authors.affiliation: Department of Urology, University College Hospital Galway, National University of Ireland, Galway, Ireland. steconnolly@rcsi.ie
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Connolly
authors.forename: Frank T
authors.initials: FT
authors.lastname: D'Arcy
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Bredin
authors.forename: John
authors.initials: J
authors.lastname: Callaghan
authors.forename: Michael O
authors.initials: MO
authors.lastname: Corcoran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D005629:Frozen Sections; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery