EAU 2011 - The role of intraoperative frozen section analysis in bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy for clinically localized prostate cancer - Session Highlights

VIENNA, AUSTRIA (UroToday.com) - This group from Italy investigated whether use of intraoperative frozen section (IFS) analysis decreases the positive surgical margin (PSMs) rate in patients with clinically localized prostate cancer (CaP) who underwent a bilateral nerve-sparing robotic assisted radical prostatectomy (RALP).

Between 2007 and 2010, 170 consecutive patients who underwent RALP with IFS for clinically organ-confined CaP had data collected. Patients were stratified according to the D’Amico risk classification. After prostate dissection, the specimen was removed and the apex and postero-lateral margins were inked. The prostate was immediately sent to the pathologist for IFS evaluation, which consisted of 2-5-mm sections of tissue taken at the inked prostate margins. A PSM was defined as the presence of tumor at the inked surface of the prostate. If the frozen section was positive, the ipsilateral neurovascular bundle was subsequently removed and sent for permanent section evaluation. A single experienced genitourinary pathologist reviewed all the cases.

Overall, 121 (71.2%) and 49 (28.8%) of patients had a low- and intermediate-risk prostate cancer. PSMs at IFS were detected in 20 (16.5%) vs. 17 (34.6%) of low- vs. intermediate-risk patients (p=0.014), respectively. Conversely, no differences in pathological stage were observed between the two groups at final pathology. Evidence of tumor in the removed neurovascular bundle was found in 6/20 (30.0%) of low-risk and 5/17 (29.4%) of intermediate-risk patients. In the low-risk group, 1 patient (0.8%) had positive IFS without demonstrating PSM at final pathology and 4 patients (3.3%) had negative IFS with a PSM at final pathology. In the intermediate-risk group, 3 patients (6.1%) had negative IFS with a PSM at final pathology. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of IFS to predict PSMs at final pathology were 83.3%, 98.9%, 95.2%, 96.0% and 95.8% in low-risk patients vs. 85.0%, 100%, 100%, 90.6% and 93.9% in intermediate-risk patients, respectively.



Presented by Nicolōmaria Buffi, MD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria


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