SIU 2017: Intraoperative Frozen Section Evaluation of the Tumor and its Base in Patients with T1 Urothelial Bladder Cancer

Lisbon, Portugal ( While transurethral resection of bladder tumor (TURBT) remains the main surgical procedure for non-muscle invasive bladder cancer, there is evidence of a high rate of under-staging for T1 disease after primary resection. Although presence of muscle is mandatory for staging purposes, nearly 40% of resected bladder specimens in TURBT do not contain muscle. Dr. Shen presented a study prospectively investigating the tumor base resected in TURBTs and whether muscle was present in the specimen using frozen section examination.

In this study from June 2011 to Oct 2016, a total of 95 consecutive patients with T1 bladder cancer were included. A standard TURBT was performed. Once the tumor was removed, the tumor base was either biopsied using cold-cup biopsy forceps or resected. An aliquot of resected tumor as well as the tumor base were both sent for pathological frozen section examination in a separate labeled pot. A repeat resection was performed if the pathological findings showed either cancer cells or muscle present in the tumor base. The results, including positive tumor base, presence of muscle in the specimen, tumor stage, residual tumor and concordance between frozen section and paraffin embedded section were compared.

Twenty six (27.4%) patients had a positive tumor base. 54 (56.8%) tumor bases were found to harbour muscle in the specimen. Of the 52 (54.7%) patients who underwent a repeat resection, 18 (34.6%) were found to harbour a residual tumor and 15 (27.8%) were upstaged to muscle invasive tumor. In the repeat resection, the paraffin embedded section demonstrated 32 (61.5%) of the specimens having muscle. The concordance of muscle in the specimen between the frozen section and paraffin embedded section was 94.7%.

Dr. Shen concludes that the frozen section examination was justified for the diagnoses of positive tumor base and muscle in the specimen, and it can help remove residual tumors and decrease understating in Tl disease during the initial TURBT.

Presented by:  Yijun Shen

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre. Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal