Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
King's College London Medical School, London, UK.
Clin Genitourin Cancer. 2024 Oct;22(5):102189. doi: 10.1016/j.clgc.2024.102189. Epub 2024 Aug 6.
Frozen section examination (FSE) of the tumor resection margins is important during penile-preserving surgery (PPS) in penile cancer. The margin status will impact on how much penile or urethral tissue is excised. We aim to evaluate the outcomes of intraoperative FSE of resection margins in PPS.
A retrospective analysis of patients with penile squamous cell carcinoma (SCC) who underwent a FSE of resection margins between 2010 and 2022 was conducted. FSEs were compared with the final histopathological analysis and the Diagnostic Testing Accuracy (DTA): sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated.
Overall, 137 FSE were performed. The median (IQR) age was 65 (53-75) years. 118 (86.1%) patients had negative FSE margins, 16 (11.7%) had positive FSE margins and 3 (2.2%) had equivocal (atypical cells) results. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of penile FSE were 66.7%, 100%, 100%, 93.2% and 94% respectively. 18 patients underwent further resection in the same episode due to a positive or equivocal FSE and 12 (66.7%) achieved negative margins. Limitations include the retrospective nature of the study and lack of control arm to compare with.
Intraoperative FSE performed at our center for the assessment of penile SCC margins is 66.7% sensitive and 100% specific. FSE should be considered in PPS, as it's an essential and a reliable diagnostic tool in minimizing over-treatment.
在阴茎癌保阴茎手术（PPS）中，肿瘤切除边缘的冰冻切片检查（FSE）非常重要。边缘状态将影响切除多少阴茎或尿道组织。我们旨在评估 PPS 中切除边缘术中 FSE 的结果。
对 2010 年至 2022 年间接受切除边缘 FSE 的阴茎鳞状细胞癌（SCC）患者进行了回顾性分析。将 FSE 与最终组织病理学分析进行了比较，并计算了诊断测试准确性（DTA）：灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
总体而言，进行了 137 次 FSE。中位（IQR）年龄为 65（53-75）岁。118 例（86.1%）患者的 FSE 边缘为阴性，16 例（11.7%）为阳性，3 例（2.2%）为不确定（异型细胞）。阴茎 FSE 的灵敏度、特异性、PPV、NPV 和诊断准确性分别为 66.7%、100%、100%、93.2%和 94%。由于 FSE 阳性或不确定，18 例患者在同一手术中进一步切除，其中 12 例（66.7%）获得了阴性边缘。局限性包括研究的回顾性和缺乏对照臂进行比较。
我们中心对阴茎 SCC 边缘进行的术中 FSE 检查的灵敏度为 66.7%，特异性为 100%。在 PPS 中应考虑 FSE，因为它是最小化过度治疗的重要且可靠的诊断工具。
