Abstract: PD49-08
Sources of Funding: None

Introduction

Intraoperative frozen section analysis (FSA) of biopsy or resection specimens often provides critical information for appropriate surgical management. However, to the best of our knowledge, there are no recent studies focusing on assessing the role of FSA in the status of surgical margins (SMs) relating to the outcomes of penectomy cases. Instead, a few review articles discourage its use in the intraoperative assessment of SMs during penectomy, mainly because lesions often show well differentiated squamous proliferation that can mimic non-neoplastic conditions. The current study aims to investigate the utility of routine FSA of the SMs in men undergoing penectomy for squamous cell carcinoma.

Methods

A retrospective review identified consecutive patients (n=38) who underwent partial (n=26) or total (n=12) penectomy for squamous cell carcinoma at our institution from 2004 to 2015. FSA findings were correlated with the diagnosis of the frozen section control, the status of final SM, and patient outcomes.

Results

FSA of the SMs was performed in 20 (77%) partial penectomies and 9 (75%) total penectomies, while no FSA was done for SMs in other cases. FSAs were reported as positive (n=3, 10%), negative (n=24, 83%), and atypical (n=2, 7%). All of the positive or negative FSA diagnoses, including those in 7 cases of well differentiated carcinoma, were confirmed accurate on the frozen section controls, whereas the 2 cases with atypical FSA had non-malignant and carcinoma cells, respectively, on the controls. Final SMs were positive in 5 (13%) penectomies (2 partial and 3 total), including 3 (10%) FSA cases versus 2 (22%) non-FSA cases (P=0.574). Furthermore, 2 initially FSA-positive/atypical cases achieved negative conversion by excision of additional tissue sent for FSA. In contrast, 2 FSA-negative cases showed carcinoma at the final SM where FSA was not submitted. During follow-up (mean: 41.2; median: 42; range: 1-136 months), 3 patients (non-FSA/final SM-negative, non-FSA/final SM-positive, FSA-negative/final SM-negative) developed tumor recurrence, and one of them (non-FSA/SM-positive) died of cancer. Kaplan-Meier analysis revealed that the number or diagnosis of FSA was not significantly associated with disease progression.

Conclusions

Overall, performing FSA during penectomy does not appear to have any significant impact on final SM status nor long-term oncologic outcomes. However, as seen in at least 2 cases, select patients may benefit from the routine FSA. Meanwhile, diagnostic accuracy of FSA of the SMs was found to be quite high.

Funding

None