title: Accuracy of urethral frozen section during radical cystectomy for bladder cancer.
abstract: Our objective was to determine the accuracy of urethral frozen section (FS) by analyzing our clinical experience.
  
  
  
  A total of 298 patients undergoing radical cystectomy for bladder cancer with benign or malignant urethral FS were identified between 2000 and 2012. Urethral FS were compared with rereviewed FS to calculate the positive and negative predictive values of the FS. To assess the ability of the positive FS to be cleared with further sampling/resection, FS were then compared with the final urethral margin. The cases of positive urethral FS were then specifically analyzed to assess rates of urethral recurrence and survival.
  
  
  
  All negative FS were confirmed to be negative on FS rereview and on final pathology, resulting in a NPV of 100%. Urethral FS were positive in 28 (8.7%) patients, of whom 2 (7%) were negative on FS rereview, yielding a positive predictive value of 93%. Both false positives were because of contamination of detached cancer from the bladder being present in the FS. After additional sampling/resection, the final margin was negative in 13 (46%) patients.
  
  
  
  A negative urethral FS reliably identifies individuals for whom urethrectomy is unnecessary and provides robust information for decision-making regarding the safety of orthotopic reconstruction. Nearly half of the patients with a positive FS were ultimately determined to have a negative final margin. Accordingly, we recommend that surgeons and pathologists discuss positive FS findings at the time of surgery and consider whether additional tissue should be analyzed in real time.
authors.affiliation: Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: mkates@jhmi.edu.
authors.forename: Max
authors.initials: M
authors.lastname: Kates
authors.affiliation: Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ball
authors.affiliation: Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Meera R
authors.initials: MR
authors.lastname: Chappidi
authors.affiliation: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Alex S
authors.initials: AS
authors.lastname: Baras
authors.affiliation: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gordetsky
authors.affiliation: Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Nikolai A
authors.initials: NA
authors.lastname: Sopko
authors.affiliation: Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Aaron
authors.initials: A
authors.lastname: Brant
authors.affiliation: Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
authors.affiliation: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.affiliation: Department of Urology, Montefiore Medical Center, Bronx, NY.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Schoenberg
authors.affiliation: Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D005629:Frozen Sections; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014521:Urethra / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents
keywords: Bladder cancer; Frozen section analysis