2008 Annual Meeting Abstracts

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Ureteral Frozen Section At The Time Of Radical Cystectomy: Is It Always Necessary?
Keith Kowalczyk, Mohan Verghese, Reza Ghasemian, Jonathan Hwang
Georgetown Univ. Hospital/Washington Hospital Center, Washington, DC

Introduction:
Ureteral margins are commonly sent for frozen section during cystectomy, but the clinical utility remain controversial. We reviewed our experience with intraoperative frozen section analysis of distal ureters in radical cystectomy series.
Methods:
Clinicopathological data was collected into a multidisciplinary database for 257 consecutive patients who underwent radical cystectomy for clinically localized bladder cancer from January 2000. All had ureteral margins sent for frozen section analysis ( per section). Frozen section results were compared with final pathological findings and clinical outcomes.
Results:
A total of 514 ureteral units were examined intraoperatively, and 32 (6.2%) had positive frozen sections, ranging from atypia to urothelial carcinoma. Of these, 15 had positive margins on permanent section, for a positive predictive value of 46.9%. On multivariate analysis, both high local T stage (T3 or T4) and the presence of diffuse CIS were the independent predictors of positive frozen section examination. Of the patients with abnormal frozen section findings, there was one case of upper tract recurrence at a mean follow-up of 38 months (range 4 to 74 months). The total cost savings for limiting frozen section on select basis in this cohort would’ve been ,600.
Conclusion:
Routine use of intraoperative frozen section analysis of the distal ureteral margins during radical cystectomy appears to be of questionable value for an organ confined disease. By limiting ureteral frozen sections to select cases such as the presence of diffuse CIS and high local cancer stage, the potential cost savings could be significant.

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