Open Access

ARTICLE

Is there a beneft to frozen section analysis at the time of partial nephrectomy?

Steven N. Sterious¹, Jay Simhan¹, Marc C. Smaldone¹, Kevin J. Tsai¹, Daniel Canter², Edward Wameedh³, Tianyu Li⁴, James Helstrom⁵, Rosalia Viterbo¹, David Y. T. Chen¹, Richard E. Greenberg¹, Alexander Kutikov¹, Tahseen Al-Saleem³, Robert G. Uzzo

1 Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
2 Department of Urology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia, USA
3 Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
4 Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
5 Department of Anesthesiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
Address correspondence to Dr. Robert G. Uzzo, Department of Surgery, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA19111 USA

Canadian Journal of Urology 2013, 20(3), 6778-6784.

Abstract

Introduction: The utility of frozen section performance during partial nephrectomy (PN) is controversial. We assessed the predictive value of frozen sections on final margin status for patients undergoing PN for localized renal tumors.
Materials and methods: We queried our prospectively maintained kidney cancer database for patients undergoing PN with localized renal tumors from 2005 to 2011. Patients were stratified based on the receipt of frozen section analysis into ‘frozen’ and ‘no frozen’ groups. Groups were compared using ANOVA, Chi-square, and Wilcoxon’s tests.
Results: A total of 537 patients (mean age 58.1 years ± 12.0 years, 64.2% male) underwent PN (mean tumor size 3.7 cm ± 2.0 cm; mean Nephrometry score 7.5 ± 1.8) from 2005 to 2011. Comparing tumor characteristics between patients undergoing frozen sections (83.1%) and those who did not (16.9%), no differences in histology, Fuhrman grade, pathologic stage, or Nephrometry score were observed between groups. Final margins were positive in 10 patients (11.0%) in the ‘no frozen’ group compared to 20 patients (4.5%) in the ‘frozen’ section group (p = 0.01). However, in patients with a documented malignancy on final pathology, final margins were positive in 5.5% and 2.9%, respectively (p = 0.16). Four patients (0.7%) had local recurrences, all of whom had negative frozen and final pathologic margins. There was no correlation between positive surgical margins and local recurrence (p = 1.0) at a median follow-up of 21 months (IQR = 9–31 months).
Conclusions: In our institutional cohort, frozen section analysis failed to impact final margin status in patients with documented renal cell carcinoma. Given the oncologic uncertainty of positive surgical margins, further prospective evaluation is necessary to determine the clinical utility of frozen section analysis.

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