Ureteral frozen sections at the time of radical cystectomy: reliability and clinical implications
Naji Touma1, Jonathan I Izawa, Mazen Abdelhady
1Departments of Surgery & Oncology, Divisions of Urology & Surgical Oncology;
Background:
We hypothesized that the incidence of ureteral abnormalities on frozen section analysis (FS) at the time of radical cystectomy is much lower than historical values and that FS has minimal impact on outcomes. We also sought to determine the accuracy of FS and the associated costs.
Methods:
We reviewed the records of 301 patients who underwent a radical cystectomy for urothelial carcinoma of the bladder (UC) between March 2000 and January 2007. The ureteral margins were sent for FS and subsequent permanent hematoxyllin and eosin (H&E) sections and results were compared. Analyses were performed to determine the costs of FS and if any association was present with the pathological stage of the primary bladder tumour and regional lymph nodes, the presence of urothelial carcinoma in situ of the bladder (CIS) and survival outcomes with the FS.
Results:
We identified 602 ureters for this study. The incidence of CIS or solid urothelial carcinoma in the ureter was 2.8%. The presence of CIS of the bladder and prostatic urethra was significantly associated with a positive FS (p = 0.02). The FS were not associated with survival outcomes. The cost to pick up 1 patient with any abnormality on FS was $2080. The cost to pick up 1 patient with CIS or solid urothelial carcinoma of the ureter on FS was $6471.
Conclusion:
The incidence of CIS and tumour on FS during radical cystectomy for UC is low. The costs associated with FS are substantial. Frozen section analysis should only be performed in select patients undergoing radical cystectomy.
Insights
Frozen section analysis (FS) for ureteral abnormalities during radical cystectomy for urothelial carcinoma (UC) is uncommon, with a 2.8% incidence. The high costs of FS suggest it should be reserved for select patients.
Area of Science:
- Urology
- Surgical Pathology
- Oncology
Background:
- Radical cystectomy is a treatment for urothelial carcinoma (UC) of the bladder.
- Frozen section analysis (FS) is used to assess ureteral margins during surgery.
- Historical data suggested higher rates of ureteral abnormalities than currently observed.
Purpose of the Study:
- To evaluate the current incidence of ureteral abnormalities detected by FS during radical cystectomy.
- To determine the accuracy and cost-effectiveness of FS for ureteral margins.
- To assess the impact of FS on patient outcomes.
Main Methods:
- Retrospective review of 301 patients undergoing radical cystectomy for UC (March 2000-January 2007).
- Comparison of FS results with permanent hematoxylin and eosin (H&E) staining for ureteral margins.
- Analysis of FS costs, association with tumor stage, and survival outcomes.
Main Results:
- Incidence of carcinoma in situ (CIS) or solid UC in the ureter was 2.8% (17 of 602 ureters).
- Positive FS was significantly associated with CIS of the bladder and prostatic urethra (p=0.02).
- FS did not correlate with survival outcomes; costs were substantial ($2080 per abnormality, $6471 per CIS/tumor).
Conclusions:
- The incidence of ureteral CIS or tumor detected by FS during radical cystectomy for UC is low.
- The costs associated with FS are significant.
- FS for ureteral margins during radical cystectomy should be selectively applied.
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