Accuracy of Frozen Section Analysis of Urethral and Ureteral Margins During Radical Cystectomy for Bladder Cancer: A Systematic Review and Diagnostic Meta-Analysis

Published on Jun 11, 2021in European urology focus5.996
路 DOI :10.1016/J.EUF.2021.05.010
Ekaterina Laukhtina8
Estimated H-index: 8
(Medical University of Vienna),
Pawel Rajwa5
Estimated H-index: 5
(Medical University of Vienna)
+ 19 AuthorsSimone Albisinni17
Estimated H-index: 17
(ULB: Universit茅 libre de Bruxelles)
Sources
Abstract
Context null The question of the ability of frozen section analysis (FSA) to accurately detect malignant pathology intraoperatively has been discussed for many decades. null Objective null We aimed to conduct a systematic review and meta-analysis assessing the diagnostic estimates of FSA of the urethral and ureteral margins in patients treated with radical cystectomy (RC) for bladder cancer (BCa). null Evidence acquisition null The MEDLINE and EMBASE databases were searched in February 2021 for studies analyzing the association between FSA and the final urethral and ureteral margin status in patients treated with RC for BCa. The primary endpoint was the value of pathologic detection of urethral and ureteral malignant involvement with FSA during RC compared with the final margin status. We included studies that provided true positive, true negative, false positive, and false negative values for FSA, which allowed us to calculate the diagnostic estimates. null Evidence synthesis null Fourteen studies, comprising 8208 patients, were included in the quantitative synthesis. Forest plots revealed that the pooled sensitivity and specificity for FSA of urethral margins during RC were 0.83 (95% confidence interval [CI] 0.38-0.97) and 0.95 (95% CI 0.91-0.97), respectively. While for the FSA of ureteral margins, the pooled sensitivity and specificity were 0.77 (95% CI 0.67-0.84) and 0.97 (95% CI 0.95-0.98), respectively. Calculated diagnostic odds ratios indicated high FSA effectiveness, and patients with a positive urethral or ureteral margin at final pathology are over 100 times more likely to have positive FSA than patients without margin involvement at final pathology. Area under the curves of 96.6% and 96.7% were reached for FSA detection of urethral and ureteral tumor involvement, respectively. null Conclusions null Intraoperative FSA demonstrated high diagnostic performance in detecting both urethral and ureteral malignant involvement at the time of RC for BCa. FSA of both urethral and ureteral margins during RC is accurate enough to be of great value in the routine management of BCa patients treated with RC. While its specificity was great to guide intraoperative decision-making, its sensitivity remains suboptimal yet. null Patient summary null We believe that the frozen section analysis of both urethral and ureteral margins during radical cystectomy should be considered more often in urologic practice, until quality of life-based cost-effectiveness studies can identify patients within each institution who are unlikely to benefit from it.
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#1Victor M. Schuettfort (Medical University of Vienna)H-Index: 5
#2Benjamin Pradere (Medical University of Vienna)H-Index: 16
Last. Shahrokh F. Shariat (Medical University of Vienna)H-Index: 136
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Purpose of review Pathomics, the fusion of digitalized pathology and artificial intelligence, is currently changing the landscape of medical pathology and biologic disease classification. In this review, we give an overview of Pathomics and summarize its most relevant applications in urology. Recent findings There is a steady rise in the number of studies employing Pathomics, and especially deep learning, in urology. In prostate cancer, several algorithms have been developed for the automatic di...
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#1Roberto CarandoH-Index: 1
#2Shahrokh F. Shariat (Medical University of Vienna)H-Index: 136
Last. David D'Andrea (Medical University of Vienna)H-Index: 18
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PURPOSE OF REVIEW: The clinical significance of ureteral and urethral recurrence in patients treated with radical cystectomy for bladder cancer is scarce and heterogeneous. The aim of the current review is to summarize the recent literature on incidence, diagnosis and oncologic outcomes of ureteral and urethral recurrences after radical cystectomy. RECENT FINDINGS: Frozen section analysis (FSA) of ureteral margin had a sensitivity and specificity of 69-77 and 83-96%, respectively. Considering th...
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#2Diaa-Eldin Taha (Kafrelsheikh University)H-Index: 7
Last. Ahmed A. Shokeir (Mansoura University)H-Index: 57
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To summarise the currently available literature and analyse available results of the outcome of intraoperative frozen-section analysis (FSA) on upper urinary tract recurrence (UUTR) after radical c...
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#1Craig Labbate (U of C: University of Chicago)H-Index: 3
#2Ryan P. Werntz (U of C: University of Chicago)H-Index: 6
Last. Gary D. Steinberg (U of C: University of Chicago)H-Index: 61
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Purpose:Current guidelines recommend confirming a negative urethral margin prior to orthotopic neobladder reconstruction. We investigated our rate of urethral positive margins and recurrence in the...
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#1Sung Ryul Shim (KU: Korea University)H-Index: 11
#2Seong-Jang Kim (PNU: Pusan National University)H-Index: 26
Last. Jong Hoo Lee (Jeju National University)H-Index: 9
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: The objective of this paper is to describe general approaches of diagnostic test accuracy (DTA) that are available for the quantitative synthesis of data using R software. We conduct a DTA that summarizes statistics for univariate analysis and bivariate analysis. The package commands of R software were "metaprop" and "metabin" for sensitivity, specificity, and diagnostic odds ratio; forest for forest plot; reitsma of "mada" for a summarized receiver-operating characteristic (ROC) curve; and "m...
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#1Joanne Tang (UTAS: University of Tasmania)H-Index: 1
#2Weranja Ranasinghe (Launceston General Hospital)H-Index: 11
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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 鈮...
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Last. Mototsugu Oya (Keio: Keio University)H-Index: 56
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Although the clinical utility of a frozen section analysis (FSA) at the time of radical cystectomy (RC) has already been established, its significance and utility in bladder cancer patients receiving neoadjuvant chemotherapy (NAC) have not yet been fully evaluated. We identified 458 patients (937 ureters) who underwent open RC for bladder cancer at our 7 Japanese institutions between 2004 and 2015. Among these patients, 139 (284 ureters) received NAC before RC (NAC group), while 319 (653 ureters...
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#1Heather Katz (Marshall University)H-Index: 5
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Last. Mohamed Alsharedi (Marshall University)H-Index: 7
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Bladder cancer is the most common malignancy involving the genitourinary system (Siegel et al. in CA Cancer J Clin, 66:7鈥30, 2016). In the USA, it is the fifth most common cancer and approximately 79,000 new cases will be diagnosed in 2017 (Siegel et al. in CA Cancer J Clin, 66:7鈥30, 2016). The mortality from bladder cancer is approximately 17,000 deaths each year (Siegel et al. in CA Cancer J Clin, 66:7鈥30, 2016). The incidence rate for bladder cancer is higher in men compared to women. Risk fa...
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#2Bernard H. BochnerH-Index: 74
Last. Jeffrey M. HolzbeierleinH-Index: 28
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