Correlation and probability value for frozen section and turbt specimens in bladder cancer

Introduction: Treatment of non-muscle invasive bladder tumors is performed by cystoscopy. When complete TUR cannot be performed and muscle tissue cannot be sampled, ReTUR should be performed. The ReTUR requirement is controversial after the deep TUR procedure, where muscle tissue is sampled. Reducing the need for ReTUR by the Frozen study is very important both for the patient to recover from a new operation and to start the treatment at an early stage. The Frozen study was aimed to confirm that muscle tissue was reached during the first TUR procedure and to demonstrate resection of the tumoral tissue until healthy tissue was seen. Materials and Methods: Twenty-seven patients who applied to Dokuz Eylul University Hospital Urology Clinic between November 2016 and July 2018 were evaluated prospectively after receiving informed consent form. Demographic data were obtained from each patient. Cystoscopy was performed to the patients with bladder mass as a result of the examinations. The tumoral formations were resected and sent frozen through the deep tissue after the TUR procedure. Then, according to the results of pathology, ReTUR was performed. Frozen, TUR and ReTUR pathology results were evaluated separately and comparatively. Results: The age of the patients ranged from 44 to 89 years, with a mean age of 67.8 ± 7.2 years. Of the 27 patients, 18.5% were female and 81.5% were male. The mean tumor size of the patients was 56.2 mm. Of the tumor pathological stages, 11.1% were Ta, 88.9% were T1, 11.1% were low and 88.9% were high grade. 12 of 27 patients were reported to have residual tumor as a result of Frozen; half of the patients had residual tumor in ReTUR pathologies, and half of them not. Frozen's sensitivity in detecting residual tumor was 50% and specificity was 60%. Frozen pathology revealed muscle tissue in 14 of the patients, 1 of them progress, 6 of them relapse or residual in ReTUR pathologies. Muscle tissue was not observed in 13 patients in Frozen section, none of them progress, 5 of them relapse or residual in ReTUR pathologies. The presence of muscle tissue in the first pathology did not cause a significant difference in the frozen results (p=0,571). Frozen's sensitivity in detecting muscle tissue was 50% and specificity was 61,5%. Conclusion: Complete removal of tumoral tissues in the first TUR procedure and sampling of muscle tissue; It is very important in terms of its effect on cancer-related survival, overall survival, progression and recurrence. Frozen is not sufficient for this sampling because it cannot be done in every center, because of the need for experienced pathologists, difficult and efficient to perform, low sensitivity and specificity. ReTUR remains the gold standard, especially in high-risk patients. More extensive studies are needed. Keywords: Bladder cancer,TUR,ReTUR,frozen