Intraoperative Frozen Section Diagnosis in Urological Oncology

doi:10.1016/j.eururo.2004.08.010

European Urology

Volume 47, Issue 2, February 2005, Pages 129-136

https://doi.org/10.1016/j.eururo.2004.08.010 Get rights and content

Abstract

The intraoperative frozen sections are indicated if the pathological findings change the surgical procedure. In urological oncology is not recommended, as a general attitude, in the tumor diagnosis/staging during the surgery. The assessment of the surgical margins is recommended in partial surgical resections but the literature discourages its systematic use in the radical surgical resections. The assessment of the lymph nodes is specially indicated in the penile cancer with intermediate or high risk and non-palpable nodes, and is debated its utility in non-palpable lymph nodes of cystectomies and prostatectomies.

Introduction

The performance of a pathologic study during surgery determines fast diagnostic decision making that is consequential upon the operation itself. Therefore, the pathologists should be solidly trained in their specialty and should also be acquainted with the surgical procedure, i.e. which technique is being used, what the surgeon wishes at the time of biopsy.

The types of intraoperative frozen sections (IFS) are quite varied. Sometimes just a small fragment of the lesion is available, and in this case the fragment is studied in its entirety. In other occasions the whole of the specimen is received and in this case it is the pathologist who chooses the most representative area in order to answer the surgeon's question. In general surgical pathology, 9.5% of errors are due to poor sampling [1], a clear-cut communication between the surgery and the pathology departments may minimize this kind of error.

The intrinsic characteristics of the technique (tissue freezing) is the cause that some pathologies, in which cell details should be subtler, are more harmed that other, as is the case with lymphomas [1].

On the other hand, with fewer sections of the specimen the ability to go in depth into the selected tissue is also diminished—approximately one-fourth of the underdiagnoses have such origin [1].

In spite of all of the above, the misdiagnosis index by IFS that is significant for the patient is very low and also dependent upon the expectations placed on such diagnosis because it is more precarious than postoperative diagnosis. For this reason the surgeon should be aware of the most precise indications and also of its limitations. The object of this review is to reflect the status of the issue in urologic oncology.

Section snippets

Handling of intraoperative frozen section specimens

All specimens sent for IFS should be fresh and contain no fixative. If the specimen is small (1–2 cm) and to avoid dehydrate during transportation, it is advisable to cover it with a gauze moistened with physiological saline; it is contraindicated to place the specimen floating in saline because the freezing process would be hindered due to the great hydric imbibition of the tissues.

The urologist should indicate any specific requirements by means of signs on the specimen; however, close

Diagnosis of a renal mass

Even though 16.9% of the renal masses excised are not carcinomas, only 13% of them are pathologies of dubious surgical treatment (complex cysts or pseudotumoral inflammatory pathologies). The rest are benign tumors, and exceptionally sarcomas or metastases whose removal is often justified [3].

The cost-effectiveness of determining the nature of an uncertain renal mass during surgery is controversial, since as high as 20%–37% of false negatives have been reported [4], with quite variable false

Intraoperative frozen section in urinary tract tumors

IFS requirement in urinary tract tumors depends of the surgical approach. Two great groups may be considered generally partial and total resections.

Intraoperative frozen section in prostate cancer

Frozen sections of cores biopsies should be refused categorically because the diagnoses are nor reliable and the material for paraffin histology is more o less destroyed. Assessment of the Gleason grade in frozen sections is extremely unreliable.

Intraoperative frozen sections in testicular tumors

The current methods of diagnosis of testicular tumor masses define their nature in a high proportion, and so it is quite rare that the pathologist is summoned intraoperatively to define them. But the evolution of the current medical attitude, which considers occasional testis-sparing surgery, as well as special circumstances of lonely testes or bilateral tumor masses or suspected non-germinal cell tumors may lead the urologist to request IFS [33].

Intraoperative frozen section in penile cancer

The IFS is discouraged for the diagnosis of penile tumor, because a lot of lesions have a well differentiated squamous cell growth that can mimic non-neoplastic lesions [39], [40] and vice versa some hyperplasic lesions can have a pseudoepitheliomatous appearance [41].

Conclusions

The IFS in urological oncology has a limited role. The accuracy and usefulness is in close relation with the urologists-pathologists communication and precise urological indication in every patient.

The IFS are not recommended, as a general attitude, in the tumor diagnosis/staging during the surgery.

The margins assessment is strongly recommended in partial resections as nephron-sparing nephrectomies, partial cystectomies, in nerve-sparing prostatectomies, and penile carcinoma specimens.

The lymph

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^☆: This publication is made under the auspices of the European Society of Uropathology (a full section office member of the European Association of Urology, EAU) and the Uropathology Working Group (European Society Pathology, ESP).

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ReviewIntraoperative Frozen Section Diagnosis in Urological Oncology☆

Abstract

Introduction

Section snippets

Handling of intraoperative frozen section specimens

Diagnosis of a renal mass

Intraoperative frozen section in urinary tract tumors

Intraoperative frozen section in prostate cancer

Intraoperative frozen sections in testicular tumors

Intraoperative frozen section in penile cancer

Conclusions

J. Urol.

J. Urol.

J. Urol.

J. Urol.

Eur. Urol.

Urology.

Eur. Urol.

J. Urol.

J. Urol.

J. Urol.

Urology.

J. Urol.

Urology.

J. Urol.

Urology.

Urol. Clin. N. Amer.

J. Urol.

Eur. Urol.

Eur. Urol.

Pathol. Res. Pract.

Urology

J. Urol.

Review
Intraoperative Frozen Section Diagnosis in Urological Oncology☆