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Intraoperative Frozen Section of the Prostate Decreases Positive Margin Rate While Ensuring Nerve Sparing Procedure During Radical Prostatectomy

2013; Lippincott Williams & Wilkins; Volume: 190; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2013.02.011

1527-3792

Christian von Bodman, Marko Brock, Florian Roghmann, Anne Byers, Björn Löppenberg, Katharina Braun, J. Pastor, Florian Sommerer, Joachim Noldus, Rein Jüri Palisaar,

Urinary Bladder and Prostate Research

No AccessJournal of UrologyAdult Urology1 Aug 2013Intraoperative Frozen Section of the Prostate Decreases Positive Margin Rate While Ensuring Nerve Sparing Procedure During Radical Prostatectomy Christian von Bodman, Marko Brock, Florian Roghmann, Anne Byers, Björn Löppenberg, Katharina Braun, Jobst Pastor, Florian Sommerer, Joachim Noldus, and Rein Jüri Palisaar Christian von BodmanChristian von Bodman Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany , Marko BrockMarko Brock Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany , Florian RoghmannFlorian Roghmann Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany , Anne ByersAnne Byers Department of Epidemiology and Biostatistics, George Washington University, Washington, D.C , Björn LöppenbergBjörn Löppenberg Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany , Katharina BraunKatharina Braun Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany , Jobst PastorJobst Pastor Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany , Florian SommererFlorian Sommerer Department of Pathology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany , Joachim NoldusJoachim Noldus Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany , and Rein Jüri PalisaarRein Jüri Palisaar Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.011AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated whether intraoperative frozen section analysis of the prostate surface might provide significant information to ensure nerve sparing and minimize the positive margin rate. Materials and Methods: In 236 patients treated with radical prostatectomy between June 2011 and September 2012 whole surface frozen section analysis of the removed prostate was done intraoperatively. The apex and base were circumferentially dissected as well as the whole posterolateral tissue corresponding to the neurovascular bundles. Multiple perpendicular sections were cut systematically for frozen section analysis. Pathology results were reported to navigate the procedure. Results: Frozen section analysis identified positive surgical margins in 22% of cases, including the neurovascular bundles in 56.9%, apex in 34.5% and base in 8.6%. Of positive frozen section cases 92.3% could be converted to negative status, while 7.7% remained positive. The final positive margin rate in the total cohort was 3%, including a false-negative frozen section rate of 1.6%. In 14.8% of cases the initial nerve sparing plan was changed intraoperatively due to the positive frozen section and the secondary resected specimen detected cancer in 25%. Final pathology results showed Gleason upgrading or up-staging in 40.7% of cases compared to preoperative variables. When comparing patients with positive vs negative frozen sections, preoperative variables did not significantly differ, while postoperatively pathological stage, tumor volume, operative time and final margin status differed significantly. Of patients with exclusively unilateral positive biopsies 13% had a positive surgical margin intraoperatively on the opposite, biopsy negative side. Conclusions: The surface frozen section technique is associated with a low false-negative surgical margin rate. It might allow for safer preservation of functional anatomical structures in misclassified patients or even patients at higher preoperative risk. 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Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 190Issue 2August 2013Page: 515-520Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsfrozen sectionsprostateprostatic neoplasmspathologyprostatectomyMetricsAuthor Information Christian von Bodman Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany More articles by this author Marko Brock Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany More articles by this author Florian Roghmann Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany More articles by this author Anne Byers Department of Epidemiology and Biostatistics, George Washington University, Washington, D.C More articles by this author Björn Löppenberg Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany More articles by this author Katharina Braun Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany More articles by this author Jobst Pastor Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany More articles by this author Florian Sommerer Department of Pathology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany More articles by this author Joachim Noldus Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany More articles by this author Rein Jüri Palisaar Department of Urology, Ruhr-University Bochum, Bochum, Germany and Marienhospital Herne, Herne, Germany More articles by this author Expand All Advertisement PDF downloadLoading ...