Chipollini Juan, Tang Dominic H, Manimala Neil, Gilbert Scott M, Pow-Sang Julio M, Sexton Wade J, Poch Michael A, Spiess Philippe E
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
Urol Oncol. 2018 Jan;36(1):14.e1-14.e5. doi: 10.1016/j.urolonc.2017.08.018. Epub 2017 Oct 9.
Inguinal lymph node dissection is an integral part in the management of invasive penile tumors with intraoperative assessment often aiding decision-making during dissection. In this study, we evaluate the diagnostic value of intraoperative frozen section (FS) and analyze clinicopathologic factors that affect its accuracy.
We, retrospectively, reviewed 84 patients with squamous cell carcinoma of the penis who underwent inguinal lymph node dissection at our institution. Intraoperative FS from the superficial inguinal nodes was available in 65 patients and compared with correspondent permanent sections (pathologic node staging [pN]). Sensitivity and specificity were calculated and factors associated with a false negative event were analyzed using logistic regression.
The total positive node rate was 60% (39/65). Of 39 pN+ cases, 10 (25.6%) had false-negative FS, whereas the remaining 29 were concordant intraoperatively. Sensitivity and specificity were 0.74 and 1, respectively. On univariable analysis, higher body mass index was associated with a false negative event although there was no association with age, receipt of neoadjuvant therapy, or clinical node stage.
Intraoperative FS is highly specific and moderately sensitive for the detection of positive superficial inguinal lymph nodes in penile cancer. Its use can help guide intraoperative surgical planning while limiting its reliance for patients with higher body mass index.
腹股沟淋巴结清扫术是侵袭性阴茎肿瘤治疗的重要组成部分，术中评估通常有助于清扫过程中的决策制定。在本研究中，我们评估了术中冰冻切片（FS）的诊断价值，并分析了影响其准确性的临床病理因素。
我们回顾性分析了在我院接受腹股沟淋巴结清扫术的84例阴茎鳞状细胞癌患者。65例患者有来自腹股沟浅淋巴结的术中FS，并与相应的永久切片（病理淋巴结分期[pN]）进行比较。计算敏感性和特异性，并使用逻辑回归分析与假阴性事件相关的因素。
总阳性淋巴结率为60%（39/65）。在39例pN+病例中，10例（25.6%）FS结果为假阴性，其余29例术中结果一致。敏感性和特异性分别为0.74和1。单因素分析显示，较高的体重指数与假阴性事件相关，而与年龄、接受新辅助治疗或临床淋巴结分期无关。
术中FS对检测阴茎癌阳性腹股沟浅淋巴结具有高度特异性和中度敏感性。其应用有助于指导术中手术规划，同时对于体重指数较高的患者限制其依赖程度。
