title: Ureteral frozen sections at the time of radical cystectomy: reliability and clinical implications.
abstract: BACKGROUND
  We hypothesized that the incidence of ureteral abnormalities on frozen section analysis (FS) at the time of radical cystectomy is much lower than historical values and that FS has minimal impact on outcomes. We also sought to determine the accuracy of FS and the associated costs.
  
  
  METHODS
  We reviewed the records of 301 patients who underwent a radical cystectomy for urothelial carcinoma of the bladder (UC) between March 2000 and January 2007. The ureteral margins were sent for FS and subsequent permanent hematoxyllin and eosin (H&E) sections and results were compared. Analyses were performed to determine the costs of FS and if any association was present with the pathological stage of the primary bladder tumour and regional lymph nodes, the presence of urothelial carcinoma in situ of the bladder (CIS) and survival outcomes with the FS.
  
  
  RESULTS
  We identified 602 ureters for this study. The incidence of CIS or solid urothelial carcinoma in the ureter was 2.8%. The presence of CIS of the bladder and prostatic urethra was significantly associated with a positive FS (p = 0.02). The FS were not associated with survival outcomes. The cost to pick up 1 patient with any abnormality on FS was $2080. The cost to pick up 1 patient with CIS or solid urothelial carcinoma of the ureter on FS was $6471.
  
  
  CONCLUSIONS
  The incidence of CIS and tumour on FS during radical cystectomy for UC is low. The costs associated with FS are substantial. Frozen section analysis should only be performed in select patients undergoing radical cystectomy.
authors.affiliation: Departments of Surgery & Oncology, Divisions of Urology & Surgical Oncology;
authors.forename: Naji
authors.initials: N
authors.lastname: Touma
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Izawa
authors.forename: Mazen
authors.initials: M
authors.lastname: Abdelhady
authors.forename: Madeleine
authors.initials: M
authors.lastname: Moussa
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin