Intraoperative and surgical specimen (ex vivo) ultrasound in the assessment of margins at partial nephrectomy.
OBJECTIVE
To correlate the accuracy of intraoperative and surgical specimen (ex vivo) ultrasound (US) with pathological margin status at partial nephrectomy.


METHODS
Patients undergoing partial nephrectomy for T1 renal tumours in the period May 2010-January 2014 at a single institution who had intraoperative specimen US were included. PN was performed by standardised technique with intraoperative tumour localisation. Following excision, surgical specimen (ex vivo) US was performed and the margin status was compared to the final histopathological analysis. The specificity of US to identify margin status was calculated as was the correlation between the ultrasonographic and final pathological margin.


RESULTS
Forty-five patients were included (median age 61 years). Mean tumour size was 28.1 ± 10 mm, and 89 % were renal cell carcinomas with the remainder being oncocytomas. Forty-four cases had negative surgical margins on pathological analysis, and US had a specificity of 100 %. There was a strong correlation between the margin as measured on US and final analysis (Pearson's r = 0.86, p < 0.001).


CONCLUSIONS
Results show that intraoperative, surgical specimen (ex vivo) US control of resection margins in patients undergoing PN is feasible and efficient. It represents a promising tool to ensure margin negativity during PN.
Department of Urology, James Cook University Hospital, Marton Road, Middlesbrough, TS43GE, UK. veeratterapillayr@doctors.org.uk.
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Veeratterapillay
Department of Urology, James Cook University Hospital, Marton Road, Middlesbrough, TS43GE, UK.
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Bromby
Department of Urology, James Cook University Hospital, Marton Road, Middlesbrough, TS43GE, UK.
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Patel
Department of Urology, James Cook University Hospital, Marton Road, Middlesbrough, TS43GE, UK.
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Sakthivel
Department of Urology, James Cook University Hospital, Marton Road, Middlesbrough, TS43GE, UK.
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Abdelbakhy
Department of Urology, James Cook University Hospital, Marton Road, Middlesbrough, TS43GE, UK.
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BD
Gowda
Department of Pathology, James Cook Hospital, Middlesbrough, UK.
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Mutton
Department of Pathology, James Cook Hospital, Middlesbrough, UK.
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Nagarajan
Department of Radiology, James Cook Hospital, Middlesbrough, UK.
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Naisby
Department of Urology, James Cook University Hospital, Marton Road, Middlesbrough, TS43GE, UK.
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Bhatti
D018249:Adenoma, Oxyphilic / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D009392:Nephrectomy / Q000379:methods*; D012680:Sensitivity and Specificity; D014463:Ultrasonography
Intraoperative ultrasound; Partial nephrectomy; Positive margin