Is there an indication for frozen section examination of the ureteral margins during cystectomy for transitional cell carcinoma of the bladder?
OBJECTIVE
We evaluated the incidence of pathological findings of the ureter at cystectomy for transitional cell carcinoma of the bladder and assessed the usefulness of intraoperative frozen section examination of the ureter.


METHODS
Histopathological findings of ureteral frozen section examination were compared to the corresponding permanent sections and the diagnostic accuracy of frozen section examination was evaluated. These segments were then compared to the more proximal ureteral segments resected at the level where they cross over the common iliac arteries. The histopathological findings of the ureteral segments were then correlated for upper urinary tract recurrence and overall survival.


RESULTS
Transitional cell carcinoma or carcinoma in situ was found on frozen section examination of the distal ureter in 39 of 805 patients (4.8%) and on permanent sections in 29 (3.6%). In 755 patients the false-negative rate of frozen section examination of the ureters was 0.8%. Of the patients with carcinoma in situ diagnosed on the first frozen section examination 80% also had carcinoma in situ in the bladder. Transitional cell carcinoma or carcinoma in situ in the most proximally resected ureteral segments was found in 1.2% of patients. After radical cystectomy there was tumor recurrence in the upper urinary tract in 3% of patients with negative ureteral frozen section examination and in 17% with carcinoma in situ on frozen section examination.


CONCLUSIONS
Routine frozen section examination of the ureters at radical cystectomy is only recommended for patients with carcinoma in situ of the bladder, provided the ureters are resected where they cross the common iliac arteries.
Schumacher
Martin C
MC
Department of Urology, Institute of Pathology, University Hospital Bern, 3010 Bern, Switzerland.
Scholz
Michael
M
Weise
Erik S
ES
Fleischmann
Achim
A
Thalmann
George N
GN
Studer
Urs E
UE
D002278:Carcinoma in Situ / Q000473:pathology; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D005629:Frozen Sections / Q000706:statistics & numerical data*; D006801:Humans; D007432:Intraoperative Period; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011446:Prospective Studies; D014513:Ureter / Q000473:pathology* / Q000601:surgery; D014516:Ureteral Neoplasms / Q000453:epidemiology / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*