Is frozen section analysis in nephron sparing surgery necessary? A clinicopathological study of 301 cases

Tel Aviv University, Tell Afif, Tel Aviv, Israel
The Journal of Urology (Impact Factor: 4.47). 03/2005; 173(2):385-7. DOI: 10.1097/01.ju.0000149111.48445.73
Source: PubMed


One of the basic principles of nephron sparing surgery for renal cell carcinoma is resection of the tumor with normal tissue margins verified by frozen section analysis. In cases of positive tumor margins the surgeon is committed to complete the local resection or to perform radical nephrectomy. In this study we retrospectively evaluated the yield of frozen section analysis performed during nephron sparing surgeries, especially concerning compatibility with the final histological report and the long-term oncological outcome.
Between 1988 and 2003, 172 men and 129 women with a mean age of 59 years (range 16 to 83) underwent nephron sparing surgery due to suspected renal tumors. Mean tumor size was 3.56 cm (range 1 to 12.5). Frozen section analysis was routinely performed during surgery.
Positive tumor margins in frozen section analysis were found in 2 cases (0.7%). In both cases the tumor was centrally located. Those 2 patients underwent immediate radical nephrectomy but no residual tumor was subsequently found in the radical nephrectomy specimens. Paraffin sections disclosed positive tumor margins in 4 other cases (1.3%) in whom the frozen section analysis had shown tumor negative margins. Of the 4 patients 1 underwent radical nephrectomy for tumor recurrence after 9 months. The other 3 patients showed no evidence of disease recurrence after 26, 59 and 120 months of followup.
Our results suggest that frozen section analysis during nephron sparing surgery has minimal clinical significance and hence routine incorporation in urological practice should be reconsidered.

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    • "Hageman et al. showed that sensitivity of GIC alone (75%) was much better than TBB alone (25%) examined by permanent section [2]. Duvdevani et al. found that frozen section TBB was positive in only 2 of the 301 (0.7%) PN patients, while an additional 4 patients (1.3%) were found to have positive surgical margins in permanent section [34]. Timsit et al. reported 100% sensitivity of macroscopic assessment of the surgical margins in undisturbed tumors in 61 patients [3]. "
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    ABSTRACT: To determine the efficacy of a new method called by us as "gross intra-operative evaluation (GIE)" for the assessment of surgical margin (SM) status. A total of 26 consecutive patients operated with cT1a-b renal tumors at a single center were included in this study. After the excision, the tumors were uniformly divided into two halves in the longitudinal axis ex vivo. In this way, margins were exposed for GIE for the evaluation of the safety of SMs. Findings of GIE were compared with the permanent section analysis in terms of SM status. Mean patient age, tumor size and margin thickness was 59 (38-79), 3.1 (1.5-6) cm and 3.7 (0.1-12) mm, respectively. In all patients, GIE showed intact margins and none of the patients had positive SM in the final pathological examination. There was no evidence of local recurrence or distant metastasis with a mean follow-up of 25 (4-104) months. All patients are alive. GIE of resected specimen without FS analysis is a safe and effective method for the evaluation of SMs in partial nephrectomy patients.
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