Intraoperative frozen section examination for penile cancer surgery: a systematic review

Penile cancer (PeCa) is rare but aggressive and life changing. Penile-preserving surgery (PPS) allows length preservation for sexual activity and normal voiding. Intraoperative frozen section examination (FSE) of resection margins helps to decide on how much penile tissue is excised. Oncological outcomes and diagnostic accuracy of FSE to date, however, are not well documented. The objective of this systematic review was to evaluate the efficacy of FSE in the treatment of PeCa and its impact on oncological outcomes. A systematic review was conducted with reference to the PRISMA statement. Studies published from 2009 to 2024 were identified through a search conducted between 1975 and 2024. The search yielded 7 studies involving 574 patients. Intraoperative FSE had a high percentage of accuracy, with a mean accuracy of 95.4% and a range of 92.9-99.4%. The mean values of sensitivity, specificity, positive predictive value, and negative predictive values were 71.4%, 99.9%, 98.8%, and 96.5%, respectively. Functional outcomes with PPS were encouraging, especially in terms of sexual function. The average local recurrence rate was 7.9%. There is a paucity of data on PeCa FSE in the literature. However, it appears that FSE is accurate and can be helpful in guiding surgeons intraoperatively when performing PPS.