根治性膀胱切除术时输尿管冰冻切片：可靠性及临床意义
Ureteral frozen sections at the time of radical cystectomy: reliability and clinical implications.
作者信息
Touma Naji, Izawa Jonathan I, Abdelhady Mazen, Moussa Madeleine, Chin Joseph L
机构信息
Departments of Surgery & Oncology, Divisions of Urology & Surgical Oncology;
出版信息
Can Urol Assoc J. 2010 Feb;4(1):28-32. doi: 10.5489/cuaj.08107.
BACKGROUND
We hypothesized that the incidence of ureteral abnormalities on frozen section analysis (FS) at the time of radical cystectomy is much lower than historical values and that FS has minimal impact on outcomes. We also sought to determine the accuracy of FS and the associated costs.
METHODS
We reviewed the records of 301 patients who underwent a radical cystectomy for urothelial carcinoma of the bladder (UC) between March 2000 and January 2007. The ureteral margins were sent for FS and subsequent permanent hematoxyllin and eosin (H&E) sections and results were compared. Analyses were performed to determine the costs of FS and if any association was present with the pathological stage of the primary bladder tumour and regional lymph nodes, the presence of urothelial carcinoma in situ of the bladder (CIS) and survival outcomes with the FS.
RESULTS
We identified 602 ureters for this study. The incidence of CIS or solid urothelial carcinoma in the ureter was 2.8%. The presence of CIS of the bladder and prostatic urethra was significantly associated with a positive FS (p = 0.02). The FS were not associated with survival outcomes. The cost to pick up 1 patient with any abnormality on FS was $2080. The cost to pick up 1 patient with CIS or solid urothelial carcinoma of the ureter on FS was $6471.
CONCLUSION
The incidence of CIS and tumour on FS during radical cystectomy for UC is low. The costs associated with FS are substantial. Frozen section analysis should only be performed in select patients undergoing radical cystectomy.
背景
我们假设在根治性膀胱切除术时，冰冻切片分析（FS）发现输尿管异常的发生率远低于既往值，且FS对预后的影响极小。我们还试图确定FS的准确性及相关成本。
方法
我们回顾了2000年3月至2007年1月期间301例行根治性膀胱切除术治疗膀胱尿路上皮癌（UC）患者的记录。输尿管切缘送去做FS及随后的永久性苏木精和伊红（H&E）切片，并比较结果。进行分析以确定FS的成本，以及其与原发性膀胱肿瘤的病理分期、区域淋巴结、膀胱原位尿路上皮癌（CIS）的存在与否以及FS与生存预后之间是否存在任何关联。
结果
本研究共确定了602条输尿管。输尿管中CIS或实性尿路上皮癌的发生率为2.8%。膀胱和前列腺尿道CIS的存在与FS阳性显著相关（p = 0.02）。FS与生存预后无关。在FS上发现1例有任何异常患者的成本为2080美元。在FS上发现1例输尿管CIS或实性尿路上皮癌患者的成本为6471美元。
结论
在UC根治性膀胱切除术中，FS时CIS和肿瘤的发生率较低。与FS相关的成本很高。冰冻切片分析仅应在接受根治性膀胱切除术的特定患者中进行。
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