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Abstract

Introduction:The objective of this study was to look at the usefulness and cost effectiveness of intraoperative frozen section analysis (FSA) of the ureters at the time of radical cystectomy.Methods:Pathology notes of patients undergoing radical cystectomy for primary bladder cancer between the years 2000-2015 at our institution were reviewed.Results:A total of 196 ureteric specimens from 98 patients were reviewed. Of the 98 patients, 9% (n = 9) had positive ureteric margins, of which all were ≥ T2, with 44% (4 of 9) being T = 4. In all cases of positive FSA, preoperative clinical staging was ≥ T2. In cases where cancer staging was upgraded post-cystectomy, there were no cases of positive FSA. After adjusting for tumor stage in ≥ T2a, using Cox regression analysis, positive frozen section was associated with a 4.2 fold increase in overall mortality (95%CI 1.3-13.8; p = 0.02). Cost associated with FSA was AU$1,351.90 to obtain 1 positive result.Conclusion:Patients with positive ureteric FSA are at higher risk of mortality post cystectomy, despite excision to negative tissue. However, FSA of the distal ureters at cystectomy were unlikely to be positive unless the bladder cancer stage was ≥ T2. Hence, routine ureteric FSA may not be necessary in patients undergoing cystectomy for non-muscle invasive bladder tumors.

Item Type:	Article
Authors/Creators:	Tang, J and Ranasinghe, W and Cheng, J and Van Es, S and Monsour, M and Cetti, R and Jensen, R and Brough, S
Keywords:	frozen section, ureter, cystectomy, mortality, cost effectiveness
Journal or Publication Title:	Current Urology
Publisher:	S. Karger AG
ISSN:	1661-7649
DOI / ID Number:	https://doi.org/10.1159/000489422
Copyright Information:	© 2019 S. Karger AG, Basel. This article is licensed under the Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.
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