Related Experiment Video
Updated: Apr 16, 2026
Author Spotlight: 3D Scanning and Augmented Reality for Enhanced Cancer Surgery Communication
Published on: December 15, 2023
Frozen section during partial nephrectomy: does it predict positive margins?
Jennifer Gordetsky1, Michael A Gorin2, Joe Canner3
1Departments of Pathology and Urology, The University of Alabama, Birmingham, AL, USA.
Objective:
To investigate the clinical utility of frozen section (FS) analysis performed during partial nephrectomy (PN) and its influence on intra-operative management.
Patients And Methods:
We performed a retrospective analysis of consecutive PN cases from 2010 to 2013. We evaluated the concordance between the intra-operative FS diagnosis and the FS control diagnosis, a postoperative quality assurance measure performed on all FS diagnoses after formalin fixation of the tissue. We also evaluated the concordance between the intra-operative FS diagnosis and the final specimen margin. Operating reports were reviewed for change in intra-operative management for cases with a positive or atypia FS diagnosis, or if the mass was sent for FS.
Results:
A total of 576 intra-operative FSs were performed in 351 cases to assess the PN tumour bed margin, 19 (5.4%) of which also had a mass sent for FS to assess the tumour type. The concordance rate between the FS diagnosis and the FS control diagnosis was 98.3%. There were 30 (8.5%) final positive specimen margins, of which four (13.3%) were classified as atypia, 17 (56.7%) as negative and nine (30%) as positive on FS diagnosis. Intra-operative management was influenced in six of nine cases with a positive FS diagnosis and in one of nine cases with an FS diagnosis of atypia.
Conclusions:
The relatively high false-negative rate, controversy over the prognosis of a positive margin, and inconsistency in influencing intra-operative management are arguments against the routine use of FS in PN cases.
Insights
Frozen section (FS) analysis during partial nephrectomy (PN) has limited clinical utility. Its routine use is not recommended due to a high false-negative rate and inconsistent impact on intra-operative decisions.
Area of Science:
- Urology
- Surgical Pathology
- Oncology
Background:
- Partial nephrectomy (PN) is a standard treatment for renal tumors.
- Frozen section (FS) analysis is sometimes used intraoperatively during PN to assess margins and tumor type.
- The clinical utility and impact of FS on intraoperative management in PN remain subjects of investigation.
Purpose of the Study:
- To investigate the clinical utility of intraoperative frozen section (FS) analysis during partial nephrectomy (PN).
- To evaluate the influence of FS on intraoperative management decisions.
- To assess the concordance rates of FS diagnoses with final pathology.
Main Methods:
- Retrospective analysis of 351 partial nephrectomy (PN) cases from 2010 to 2013.
- Evaluation of concordance between intraoperative FS, FS control diagnosis, and final specimen margins.
- Review of operating reports for changes in intraoperative management based on FS results.
Main Results:
- A total of 576 intraoperative FSs were performed.
- High concordance (98.3%) was observed between intraoperative FS and FS control diagnoses.
- A 5.4% rate of FS for tumor type assessment was noted.
- Final positive margins occurred in 8.5% of cases.
- Intraoperative management was influenced in a minority of cases with positive or atypical FS findings.
Conclusions:
- The routine use of frozen section (FS) in partial nephrectomy (PN) is not supported.
- Arguments against routine FS include a relatively high false-negative rate and inconsistent impact on intraoperative management.
- Controversy surrounding the prognosis of positive margins further questions the utility of intraoperative FS in PN.
