The impact of routine frozen section analysis during partial cystectomy for bladder cancer on surgical margin status and long-term oncologic outcome

Abstract

ObjectivesThe utility of frozen section analysis (FSA) during partial cystectomy has not been established. We assessed the impact of intraoperative FSA in partial cystectomy cases on surgical margin (SM) status and patient outcome. Subjects and methodsA retrospective review identified 76 consecutive patients who underwent partial cystectomy for bladder carcinoma with (n = 66; 87%) or without (n = 10; 13%) FSA for SMs at our institution from 2004 to 2018. FSA was correlated with the diagnosis of the frozen section control, the status of final SM, and the prognosis. ResultsFinal SM was positive in 9 (12%) cystectomies, including 6 (9%) FSA vs. 3 (30%) non-FSA cases (P = 0.091). There were no significant differences in tumor size, histology, or tumor grade/stage between the 2 cohorts. FSAs were reported as positive (n = 7; 11%), atypical (n = 10; 15%), and negative (n = 49; 74%). All of the positive and negative FSA diagnoses were confirmed accurate on the frozen section controls, whereas atypical diagnoses were revised to benign (n = 4), atypical (n = 4), and carcinoma (n = 2) on the controls. Ten (77%) of 13 initial FSA-positive (6 of 7)/atypical (4 of 6; excluding benign diagnoses on the controls) cases achieved negative conversion by excision of additional tissue. Thus, final SM was positive in 1 (14%) FSA-positive case, 3 (30%) FSA-atypical cases (including one at the SM where FSA was not sampled), and 2 (4%) FSA-negative cases (at the SM where FSA was not sampled). Kaplan-Meier analysis and log-rank test revealed an association of performing FSA with the risk of disease progression (P = 0.021), but not intravesical recurrence (P = 0.434) or cancer-specific mortality (P = 0.560). Initial positive/atypical FSA, as an independent prognosticator, was associated with reduced progression-free (P = 0.002) and cancer-specific (P = 0.004) survival rates, compared with initial negative FSA. Positive SM was also associated with a larger tumor size (P < 0.05) and a higher risk of intravesical recurrence (P = 0.070) or disease progression (P = 0.096). ConclusionsPerforming FSA during partial cystectomy may contribute to preventing positive SM and disease progression. Additionally, as seen in most of initial FSA-positive/atypical cases that achieved negative conversion, select patients may benefit from the routine FSA. Meanwhile, positive or atypical FSA was associated with significantly poorer prognosis.