Fiabilité de l'examen extemporané en pathologie urologique tumorale

The intraoperative pathology consultation is indicated if the findings have an impact on the surgical procedure. In urological oncology, pathologists can be requested to evaluate the nature of the tumor, to determine the metastatic status of lymph node resections or to assess the surgical margins. The identification of the benign nature of a tumor on frozen sections can allow organ sparing surgery, but must be limited to some cases of renal and testicular lesions. Intraoperative examination of pelvic lymph nodes detects metastasis with a low incidence and a weak reliability to diagnose micrometastasis. The surgical margin status after partial nephrectomy do not have to be assess on tumor bed biopsies, but on the whole surgical specimen, and a macroscopic exam is most of time sufficient. Intraoperative evaluation of the margin status after radical prostatectomy is a difficult exam that needs a well-trained pathologist and that must be limited to posterolateral areas in case of nerve bundle preservation.