Clinical benefits of frozen section assessment during urological surgery: Does it contribute to improving surgical margin status and patient outcomes as previously thought?

Abstract

Abbreviations & Acronyms CIS = carcinoma in situ FSA = frozen section assessment MRI = magnetic resonance imaging NA = not available NVB = neurovascular bundle PSA = prostate-specific antigen RCC = renal cell carcinoma RP = radical prostatectomy SM = surgical margin Abstract: Despite significant advances in patient selection as well as surgical technique over the past few decades, it is still not uncommon for patients with urological malignancy and positive surgical margins to be observed. Meanwhile, intraoperative pathology consultation with frozen section assessment, which generally provides useful information for the optimal procedure, has been widely utilized for the assessment of surgical margins during urological surgeries. Thus, it remains unanswered whether intraoperative frozen section assessment has an impact on final surgical margin status as well as long-term oncological outcomes. The present review summarizes and discusses available data assessing the utility of frozen section assessment of the surgical margins during urological surgeries, such as radical prostatectomy, partial nephrectomy and radical cystectomy. The current findings suggest that select patients might benefit from the routine frozen section assessment.

The impact on oncological outcomes after radical prostatectomy for prostate cancer of converting soft tissue margins at the apex and bladder neck from tumour‐positive to ‐negative

“…In a few studies comparing outcomes after RP with and without IFS, IFS was associated with a marginally lower risk of biochemical recurrence after RP . In the present study period, 107 of 2 242 patients underwent RP without IFS analysis.…”

How accurate is frozen section pathology compared to permanent pathology in detecting involved margins and lymph nodes in breast cancer?

“…However, the latter includes suboptimal tissue preparation as a result of histological frozen artifact, cautery artifact, and/or inadequate sampling, any of which might result in an indeterminate or inaccurate diagnosis. Although the diagnostic accuracy of FS pathology is not perfect, it is also dependent on the pathologist’s knowledge and experience [ 5 ]. Other limitations of this method include prolonging the operation time, high probability of false negatives in patients who have received new joint therapy, are not reliable in specific BC subtypes such as invasive lobular cancer or ductal carcinoma in situ (DCIS), and further add to the health care costs [ 6 ].…”

The value of transperineal apical prostate biopsy in predicting urethral/apical margin status after radical prostatectomy

“…[27,29] Additionally, in some of the cases, especially with extensive tumor, positive surgical margins could be identified on RP specimens at the sites where frozen section assessment was not carried out. [30] Thus, there is currently no clear consensus as to patient selection, as well as the appropriate site of margin tissue and the number of the specimens sampled for frozen section consultation.…”