title: Ureteral and urethral frozen sections during radical cystectomy or cystoprostatectomy: an analysis of denudation and atypia.
abstract: OBJECTIVE
  To evaluate denudation (no urothelium present for evaluation) and atypia (urothelial carcinoma in situ [CIS] cannot be ruled out) on frozen sections (FSs) of ureteral and urethral margins in radical cystectomies and cystoprostatectomies.
  
  
  METHODS
  In radical cystectomies from 2000-2012, we compared FS diagnoses with the corresponding permanent section of the same tissue (frozen section control [FSC]). We also compared FS to "any CIS," which assessed whether there was any CIS in a given ureter or urethra, combining the diagnoses on "frozen section control" and on all submitted ureteral and urethral sections in a case.
  
  
  RESULTS
  We analyzed 1222 ureteral and 366 urethral FSs in 822 surgical cases. On FS for ureters, there were 56 diagnoses of atypia, 19 (33.9%) of which showed CIS on FSC, and 81 diagnoses of denudation, 1 (1.2%) of which showed CIS on FSC. On FS for urethras, there were 12 diagnoses of atypia, 2 (16.7%) of which showed CIS on FSC, and 17 diagnoses of denudation, 1 (5.9%) of which showed CIS on FSC. Twenty-three patients (38.3%) with atypia and 14 patients (15.0%) with denudation on FS had a finding of "any CIS." A diagnosis of either atypia or denudation on FS was predictive of finding CIS on FSC and "any CIS" in a given ureter or urethra (P <.0001). Half of margins positive for CIS on the first FS were converted to a final negative margin by resecting additional tissue.
  
  
  CONCLUSIONS
  After an FS diagnosis of atypia or denudation, urologists should obtain additional margins if surgically feasible.
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gordetsky
authors.affiliation: Department of Urology and Oncology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Trinity
authors.initials: T
authors.lastname: Bivalacqua
authors.affiliation: Department of Urology and Oncology, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Mark
authors.initials: M
authors.lastname: Schoenberg
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD; Department of Urology and Oncology, The Johns Hopkins Hospital, Baltimore, MD. Electronic address: jepstein@jhmi.edu.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
mesh_terms: D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology*; D015925:Cryopreservation; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000473:pathology*; D019459:Urothelium / Q000473:pathology*