The value of frozen-section analysis of ureteric margins on surgical decision-making in patients undergoing radical cystectomy for bladder cancer.

Objective: To prospectively investigate the value of routine frozen-section analysis (FSA) of the ureteric margin for detecting distal ureteric malignancy in patients undergoing cystectomy for bladder transitional cell carcinoma (TCC).

Patients And Methods: In all, 100 consecutive patients had a radical cystectomy for TCC of the bladder; routine FS biopsies were obtained from the lower ureters of all. Definitive pathology with step-sectioning of the lower ureters was reviewed, and the results of paraffin-wax embedded sections and FSA were compared. The true incidence of distal ureteric malignancy was identified and correlated with different clinical and pathological variables.

Results: There were 193 ureteric specimens examined; 16 ureters (8.3%) in 14 patients showed evidence of malignancy by FSA. True distal ureteric malignancy was diagnosed in 29 ureteric specimens (15%) in 24 patients. The sensitivity and specificity of the FSA were 45% and 98%, respectively, while the positive and negative predictive values were 81% and 91%, respectively. There was no significant correlation between distal ureteric malignancy and: patient age, tumour site or morphology, clinical or pathological staging, ipsilateral hydronephrosis, suspicious intraoperative ureter, biopsy or tumour grade, associated carcinoma in situ or nodal involvement. Male gender and positive intraoperative FSA were the only predictors significantly associated with distal ureteric malignancy by univariate analysis (P = 0.01 and <0.01, respectively). Both predictors remained significant on multivariate analysis.

Conclusion: A positive ureteric FSA during cystectomy has a high predictive value in the diagnosis of distal ureteric malignancy, and is justified as an independent predictor in male patients with bladder TCC.