Oncology Ureteral and Urethral Frozen Sections During Radical Cystectomy or Cystoprostatectomy: An Analysis of Denudation and Atypia Jennifer Gordetsky, Trinity Bivalacqua, Mark Schoenberg, and Jonathan I. Epstein OBJECTIVE
MATERIALS AND METHODS
RESULTS
CONCLUSION
To evaluate denudation (no urothelium present for evaluation) and atypia (urothelial carcinoma in situ [CIS] cannot be ruled out) on frozen sections (FSs) of ureteral and urethral margins in radical cystectomies and cystoprostatectomies. In radical cystectomies from 2000-2012, we compared FS diagnoses with the corresponding permanent section of the same tissue (frozen section control [FSC]). We also compared FS to “any CIS,” which assessed whether there was any CIS in a given ureter or urethra, combining the diagnoses on “frozen section control” and on all submitted ureteral and urethral sections in a case. We analyzed 1222 ureteral and 366 urethral FSs in 822 surgical cases. On FS for ureters, there were 56 diagnoses of atypia, 19 (33.9%) of which showed CIS on FSC, and 81 diagnoses of denudation, 1 (1.2%) of which showed CIS on FSC. On FS for urethras, there were 12 diagnoses of atypia, 2 (16.7%) of which showed CIS on FSC, and 17 diagnoses of denudation, 1 (5.9%) of which showed CIS on FSC. Twenty-three patients (38.3%) with atypia and 14 patients (15.0%) with denudation on FS had a finding of “any CIS.” A diagnosis of either atypia or denudation on FS was predictive of finding CIS on FSC and “any CIS” in a given ureter or urethra (P 50% loss of urothelium. Chi square test was used for comparison of diagnoses of atypia or denudation to diagnoses of benign or CIS.
RESULTS We looked at 822 consecutive radical cystectomy specimens. This included 1222 ureteral and 366 urethral “frozen sections.” One hundred thirty-eight patients had diagnoses of either atypia and/or denudation found on “frozen section” of ureteral and urethral margins (Supplementary Table 1). On “frozen section” of the ureters, there were 56 diagnoses of atypia, 19 (33.9%) of which showed CIS on the “frozen section control” (Fig. 1B), and 81 diagnoses of denudation, only 1 (1.2%) of which showed CIS on the “frozen section control” (Table 1). On “frozen sections” of urethras, there were 12 diagnoses of atypia, 2 (16.7%) of which showed CIS on “frozen section control,” and 17 diagnoses of denudation, only 1 (5.9%) of which showed CIS on “frozen section control” (Table 2). Additionally, we evaluated if the finding of denudation or atypia on “frozen section” corresponded to a finding of “Any CIS” (Table 3). There were 67 cases that had a diagnosis of atypia on either ureteral or urethral “frozen section.” One of these cases had atypia found on both a UROLOGY 84 (3), 2014
Table 1. Ureter frozen sections
Table 2. Urethra frozen sections
FSC Diagnosis
FSC Diagnosis
FS Diagnosis
CIS
Benign Atypia Denudation
Total
FS Diagnosis
CIS
Benign
Atypia
Denudation
Total
Benign CIS Atypia Denudation Total
4 148 19 1 172
930 0 29 72 1031
934 151 56 81 1222
Benign CIS Atypia Denudation Total
0 36 2 1 39
301 0 9 13 323
0 0 1 0 1
0 0 0 3 3
301 36 12 17 366
0 3 8 1 12
0 0 0 7 7
CIS, urothelial carcinoma in situ; FS, “frozen section”; FSC, “frozen section control.” P
MATERIALS AND METHODS
RESULTS
CONCLUSION
To evaluate denudation (no urothelium present for evaluation) and atypia (urothelial carcinoma in situ [CIS] cannot be ruled out) on frozen sections (FSs) of ureteral and urethral margins in radical cystectomies and cystoprostatectomies. In radical cystectomies from 2000-2012, we compared FS diagnoses with the corresponding permanent section of the same tissue (frozen section control [FSC]). We also compared FS to “any CIS,” which assessed whether there was any CIS in a given ureter or urethra, combining the diagnoses on “frozen section control” and on all submitted ureteral and urethral sections in a case. We analyzed 1222 ureteral and 366 urethral FSs in 822 surgical cases. On FS for ureters, there were 56 diagnoses of atypia, 19 (33.9%) of which showed CIS on FSC, and 81 diagnoses of denudation, 1 (1.2%) of which showed CIS on FSC. On FS for urethras, there were 12 diagnoses of atypia, 2 (16.7%) of which showed CIS on FSC, and 17 diagnoses of denudation, 1 (5.9%) of which showed CIS on FSC. Twenty-three patients (38.3%) with atypia and 14 patients (15.0%) with denudation on FS had a finding of “any CIS.” A diagnosis of either atypia or denudation on FS was predictive of finding CIS on FSC and “any CIS” in a given ureter or urethra (P 50% loss of urothelium. Chi square test was used for comparison of diagnoses of atypia or denudation to diagnoses of benign or CIS.
RESULTS We looked at 822 consecutive radical cystectomy specimens. This included 1222 ureteral and 366 urethral “frozen sections.” One hundred thirty-eight patients had diagnoses of either atypia and/or denudation found on “frozen section” of ureteral and urethral margins (Supplementary Table 1). On “frozen section” of the ureters, there were 56 diagnoses of atypia, 19 (33.9%) of which showed CIS on the “frozen section control” (Fig. 1B), and 81 diagnoses of denudation, only 1 (1.2%) of which showed CIS on the “frozen section control” (Table 1). On “frozen sections” of urethras, there were 12 diagnoses of atypia, 2 (16.7%) of which showed CIS on “frozen section control,” and 17 diagnoses of denudation, only 1 (5.9%) of which showed CIS on “frozen section control” (Table 2). Additionally, we evaluated if the finding of denudation or atypia on “frozen section” corresponded to a finding of “Any CIS” (Table 3). There were 67 cases that had a diagnosis of atypia on either ureteral or urethral “frozen section.” One of these cases had atypia found on both a UROLOGY 84 (3), 2014
Table 1. Ureter frozen sections
Table 2. Urethra frozen sections
FSC Diagnosis
FSC Diagnosis
FS Diagnosis
CIS
Benign Atypia Denudation
Total
FS Diagnosis
CIS
Benign
Atypia
Denudation
Total
Benign CIS Atypia Denudation Total
4 148 19 1 172
930 0 29 72 1031
934 151 56 81 1222
Benign CIS Atypia Denudation Total
0 36 2 1 39
301 0 9 13 323
0 0 1 0 1
0 0 0 3 3
301 36 12 17 366
0 3 8 1 12
0 0 0 7 7
CIS, urothelial carcinoma in situ; FS, “frozen section”; FSC, “frozen section control.” P
