Ureteral and Urethral Frozen Sections During Radical Cystectomy or Cystoprostatectomy: An Analysis of Denudation and Atypia

ObjectiveTo evaluate denudation (no urothelium present for evaluation) and atypia (urothelial carcinoma in situ [CIS] cannot be ruled out) on frozen sections (FSs) of ureteral and urethral margins in radical cystectomies and cystoprostatectomies.Materials and MethodsIn radical cystectomies from 2000-2012, we compared FS diagnoses with the corresponding permanent section of the same tissue (frozen section control [FSC]). We also compared FS to “any CIS,” which assessed whether there was any CIS in a given ureter or urethra, combining the diagnoses on “frozen section control” and on all submitted ureteral and urethral sections in a case.ResultsWe analyzed 1222 ureteral and 366 urethral FSs in 822 surgical cases. On FS for ureters, there were 56 diagnoses of atypia, 19 (33.9%) of which showed CIS on FSC, and 81 diagnoses of denudation, 1 (1.2%) of which showed CIS on FSC. On FS for urethras, there were 12 diagnoses of atypia, 2 (16.7%) of which showed CIS on FSC, and 17 diagnoses of denudation, 1 (5.9%) of which showed CIS on FSC. Twenty-three patients (38.3%) with atypia and 14 patients (15.0%) with denudation on FS had a finding of “any CIS.” A diagnosis of either atypia or denudation on FS was predictive of finding CIS on FSC and “any CIS” in a given ureter or urethra (P <.0001). Half of margins positive for CIS on the first FS were converted to a final negative margin by resecting additional tissue.ConclusionAfter an FS diagnosis of atypia or denudation, urologists should obtain additional margins if surgically feasible.