title: Frozen section analysis of ureteral margins in patients undergoing radical cystectomy for bladder cancer: differential impact of carcinoma in situ in the bladder on reliability and impact on tumour recurrence in the upper urinary tract.
abstract: BACKGROUND
  Patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) are at risk for upper urinary tract recurrence (UUTR), especially in case of carcinoma in situ (CIS). Data on the impact of CIS in the urinary bladder on ureteral tumour involvement or UUTR are conflicting. We presently evaluate the accuracy of intraoperative frozen section analysis (FSA) of the ureteral margin, the incidence of ureteral tumour involvement and their impact on UUTR in patients undergoing RC for UCB with versus without CIS of the bladder.
  
  
  METHODS
  Between 2003 and 2007, 243 patients underwent RC in our department. 176 of these for UCB, either without CIS (n = 117, group I) or solitary/concomitant CIS (n = 59, group II). FSA was performed. Patients were followed up for UUTR.
  
  
  RESULTS
  Overall, 403 ureteral margins--including re-resections--were analysed (group I, n = 232; group II, n = 171). One patient (0.85%) in group I and 21 patients (35.6%) in group II had tumour involvement of the ureter (p < 0.0001) at the time of RC. The false-negative rate of FSA compared to final histopathology was 0.4% (1/232) for group I and 2.9% (5/171) for group II, respectively. Mean duration of follow-up was 26 months (1-72). In group II, 2 patients (1.1%) had UUTR in the follow-up; both had initially positive and subsequently false-negative FSA.
  
  
  CONCLUSIONS
  Tumour involvement of the ureter is found significantly more often in solitary or concomitant CIS of the bladder. Intraoperative ureteral FSA is accurate and should be recommended in these patients. Ureteral tumour involvement predisposes to UUTR especially with initial positive margins mandating careful follow-up.
authors.affiliation: Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center, Wuerzburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Loeser
authors.forename: Tiemo
authors.initials: T
authors.lastname: Katzenberger
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Vergho
authors.forename: Arkadius
authors.initials: A
authors.lastname: Kocot
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Hubertus
authors.initials: H
authors.lastname: Riedmiller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*