The clinical significance of intra-operative ureteral frozen section analysis at radical cystectomy for urothelial carcinoma of the bladder.
OBJECTIVE
To evaluate the clinical significance of intra-operative ureteral frozen section analysis (FSA) at the time of radical cystectomy.


METHODS
A total of 402 patients underwent radical cystectomy for urothelial carcinoma of the bladder at our institution from January 1991 to December 2011. Except for 35 ureters who underwent nephroureterectomy, 769 ureters were finally identified. Among these, FSA was performed at 645 ureters (83.8 %). If the first FSA result was positive for malignancy (carcinoma in situ or carcinoma) or demonstrated atypia or dysplasia, sequential ureteral resection was undertaken until normal urothelium was identified, when possible.


RESULTS
A total of 54 ureters (8.4 %) of 46 patients (11.2 %) had ureteral involvement (positive) on the first FSA. On permanent section analysis (PSA), ureteral involvement was noted in 40 ureters (6.2 %) of 35 patients (8.7 %). The sensitivity, specificity, and accuracy of FSA were approximately 75, 96, and 95 %, respectively. Intramural tumor invasion was correlated with ureteral involvement on both FSA and PSA (p < 0.05). There was no correlation between upper urinary tract (UUT) recurrence and ureteral involvement on FSA and PSA. Positive FSA and PSA were not risk factors associated with overall and cancer-specific survival (CSS) on multivariate analysis.


CONCLUSIONS
Intra-operative FSA can reasonably detect ureteral involvement. However, a relatively high false-positive rate (44 %) may be problematic and has the likelihood to overestimate disease at the ureteral margin. Overall, routine FSA of the ureters shows no correlation with UUT recurrence as well as overall and CSS.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Hyung Suk
HS
Kim
Kyung Chul
KC
Moon
Chang Wook
CW
Jeong
Cheol
C
Kwak
Hyeon Hoe
HH
Kim
Ja Hyeon
JH
Ku
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016616:Cryoultramicrotomy / Q000379:methods*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000175:diagnosis* / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*