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Ureteral frozen section analysis during cystectomy: a reassessment
M P Schoenberg1, H B Carter, J I Epstein
1James Buchanan Urological Institute, Johns Hopkins Medical Institution, Baltimore, Maryland 21287-6101, USA.
The Journal of Urology
|April 1, 1996
Summary
Routine frozen section analysis of ureteral margins during cystectomy may not be necessary. Urothelial abnormalities are uncommon, and their clinical significance is questionable, suggesting a potential shift in surgical practice for bladder cancer management.
Area of Science:
- Urologic Oncology
- Surgical Pathology
- Cancer Diagnosis
Background:
- Frozen section analysis of distal ureteral margins is standard practice during cystectomy.
- This procedure aims to detect tumor involvement in the retained ureter.
Purpose of the Study:
- To determine the incidence and clinical significance of urothelial abnormalities detected by intraoperative frozen section analysis.
- To evaluate the necessity of routine frozen section analysis of ureteral margins in cystectomy patients.
Main Methods:
- Retrospective review of pathology reports for 101 consecutive cystectomies.
- Comparison of frozen section findings with final ureteral margin analyses.
Main Results:
- 8% of patients showed urothelial abnormalities (mild atypia to carcinoma in situ) on frozen section.
- False-positive and false-negative rates for frozen section were 2% and 6%, respectively.
- Despite positive margins in 6 patients, ureterointestinal anastomosis was performed without subsequent upper tract recurrence in 41 months mean follow-up.
Conclusions:
- Routine frozen section analysis of ureteral margins may not be essential for most cystectomy patients.
- The clinical significance of detected urothelial abnormalities on frozen section warrants further investigation.
- These findings suggest a potential to streamline the cystectomy procedure by reconsidering routine frozen section analysis.