Is intraoperative frozen section analysis an efficient way to reduce positive surgical margins? Journal Article
| Authors: | Tsuboi, T.; Ohori, M.; Kuroiwa, K.; Reuter, V. E.; Kattan, M. W.; Eastham, J. A.; Scardino, P. T. |
| Article Title: | Is intraoperative frozen section analysis an efficient way to reduce positive surgical margins? |
| Abstract: | Objectives. To assess the accuracy and efficiency of frozen section analysis to detect positive surgical margins (+SMs) during radical prostatectomy. Methods. In a consecutive series of 760 patients treated with radical prostatectomy from 1998 to 2002, areas suspicious for +SMs on the surface of the removed prostate were examined by frozen section analysis. In a subset of 520 patients, the surgeon's level of suspicion for +SMs was scored and recorded during radical prostatectomy. Results. Overall, 259 patients underwent frozen section examination. Of these, 55 patients (21%) had +SMs on permanent section examination compared with 50 (10%) of 501 patients with no frozen section analysis (P <0.005). Cancer was present in 23 (8.9%) frozen section specimens, all of which were confirmed on permanent section analysis. Frozen section examination missed 32 +SMs in 236 patients with negative frozen section results. The sensitivity, specificity, and positive and negative predictive value of frozen section analysis to identify +SMs was 42%, 100%, 100%, and 86%, respectively. However, the sensitivity of frozen section analysis was much lower (23 of 105, 22%) when analyzed for the entire population, including those who did not have frozen section analysis. Among the subset of 520 patients with the level of suspicion recorded, 79 had a +SM on permanent section examination. However, 51 (64%) of these were in patients with no suspicious area in the prostatectomy specimen. Conclusions. Although the positive predictive value of frozen section analysis for +SMs is high, the sensitivity is too low to expect that a policy of routine frozen section analysis of suspicious areas will reduce the rate of +SMs substantially. © 2005 Elsevier Inc. |
| Keywords: | adult; controlled study; human tissue; treatment outcome; aged; middle aged; surgical technique; major clinical study; diagnostic accuracy; sensitivity and specificity; intraoperative care; reproducibility of results; prediction; prostate cancer; prostatic neoplasms; prostate; intraoperative period; prostatectomy; scoring system; intermethod comparison; frozen section; frozen sections |
| Journal Title: | Urology |
| Volume: | 66 |
| Issue: | 6 |
| ISSN: | 0090-4295 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2005-12-01 |
| Start Page: | 1287 |
| End Page: | 1291 |
| Language: | English |
| DOI: | 10.1016/j.urology.2005.06.073 |
| PUBMED: | 16360458 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 25" - "Export Date: 24 October 2012" - "CODEN: URGYA" - "Source: Scopus" |
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