Target urgent study of fresh frozen sections to define the surgical margin status during radical prostatectomy

Abstract

Introduction. Radical prostatectomy (RP) is the "gold standard" treatment for patients with prostate cancer (PCa). Obviously, one of the predictors actively studied of biochemical recurrence is the presence of a positive surgical margin.Objective. To develop and initially evaluate the techniques of targeted urgent intraoperative histological study of fresh frozen sections during radical prostatectomy.Materials & methods. This study was carried out within the framework of the academic research at the University Clinic of Urology, Pirogov Medical University. We conducted a prospective clinical study of fresh frozen tissue samples during laparoscopic RP (LPR). The subject of the investigation are 112 patients with PCa underwent LRP (extra- and transperitoneal approaches) by one surgeon in 2021 – 2022. Group A involves 62 patients underwent intraoperative examination of fresh frozen sections based on preoperative data (MRI, FUSION biopsy). Group B (control retrospective group) consists of 50 patients with standard surgery without fresh frozen sections.Results. The accumulation of new data allows us to say that the presence of an oncological process was found in the gross specimen obtained by performing cito histology in 42 (67.7%) patients. A primary positive margin was found in 12 (19.4%). Compared to group B, a positive surgical margin was found in 7 (14%). Migration of surgical margin status from initially negative to finally positive margin found in 2 (3.3%). Migration of status from primary positive to negative surgical margin was found in 2 (3.3%). The specificity of the method (true negative margin) was determined in 48 of 50 patients (96.1%), and the sensitivity (true positive margin) was determined in 10 of 12 patients (83.3%). The average time to complete the technique of rapid histological study was 27 minutes.Conclusion. Since the work carried out, we have come to the following conclusion that the obtained results indicate the effectiveness and expediency of using targeted urgent histological study during RP.