Login to Access Video or Poster Abstract: MP80-08
Sources of Funding: none

Introduction

In patients with inconclusive testicular lesions, frozen section examination (FSE) during inguinal exploration is recommended by the current European Association of Urology (EAU) guidelines. However, FSE is not available to every urologist, is time consuming, and the diagnostic value of FSE remains poorly defined. The aim of this investigation was to assess the diagnostic value of FSE during inguinal exploration.

Methods

We reviewed the medical records of patients undergoing inguinal exploration and FSE between 1999 and 2015 in a tertiary care academic center. Patients demographic and clinical information were extracted. The results from FSE and final pathology were compared.

Results

FSEs were performed on 142 testicular lesions during inguinal exploration of the affected testis. Germ cell tumors (GCT) and non-GCT pathologies were correctly identified in 106 cases (74.6%, 46 non-seminomas, 60 seminomas) and 35 cases (24.6%), respectively. One case was incorrectly classified as non-malignant hypocellular nodule on FSE. However, final pathology revealed a seminoma. The patient underwent a secondary inguinal orchiectomy and remains disease-free 6 years post orchiectomy under active surveillance. No patient underwent unnecessary orchiectomy due to an incorrectly classified testicular GCT. According to our data, FSE has a sensitivity of 99% (95% CI 95%-100%), a specificity of 100% (95% CI 85%-100%), a positive predictive value of 100% (95% CI 95%-100%) and a negative predictive value of 97% (95% CI 85%-100%).

Conclusions

FSE is a useful diagnostic tool, which reliably predicts the presence or absence of GCT and thus is helpful to guide intraoperative management of testicular lesions particularly in patients with inconclusive preoperative results (i.e. negative tumor markers). To minimize the rate of unnecessary orchiectomies, these patients should only be treated in institutions where FSE is available.

Funding

none