Value of frozen section analysis with suspected testicular malignancy

Abstract

Objectives To determine whether frozen section analysis (FSA) assists safe conservative surgery for men presenting with suspected testicular tumors. Methods We performed a retrospective review of intraoperative testicular FSA used at a single university institution during an 11-year period. The exclusion criteria included lesions of paratesticular origin, size greater than 5 cm, and the known presence of elevated tumor markers or metastatic disease. Results Eighty men underwent FSA, facilitating the diagnosis of germ cell malignancy in 51 (54.3%) of the 94 new cases encountered during this period. Malignancy was reported by FSA in 52 patients (65.0%), but was later revised in 3 to benign Leydig cell tumor after orchiectomy. Also, 2 of 27 specimens reported as benign by FSA were revised to malignant after analysis of paraffin-embedded tissue from the biopsies. Both were seminoma and required delayed orchiectomy. FSA was reported as “suspicious” (intratubular germ cell neoplasia with necrosis) in 1 patient, in whom orchiectomy was performed and malignancy confirmed. In total, orchiectomy was avoided in 25 cases (31.3%). The positive and negative predictive value for FSA in the diagnosis of testicular malignancy was 94.2% and 92.6%, respectively. Of 13 lesions 1 cm or less, 10 (76.9%) were benign. All 26 lesions greater than 3 cm were malignant. A clear correlation between lesion size and the diagnosis of malignancy was demonstrated. Conclusions FSA is a valuable tool assisting testicular preservation. Lesion size correlated with incidence of malignancy; therefore, FSA may be best used for small testicular lesions suitable for excision biopsy.