Presented by: Tal Cohen MD
Mayo Clinic

Introduction

 Upper tract urothelial carcinoma (UTUC) represents 5% of all urothelial malignancies. Accurate pathologic diagnosis is key and may direct treatment decisions.  Current ureteroscopic biopsy techniques include cold-cup, backloaded cold-cup and stone basket. The study objective was to compare frozen section pathology with final permanent pathology to determine correlation.  This would help determine whether intraoperative decision making can be based on frozen section results.

Materials

We performed ureteroscopic biopsy using the “form tackle” technique as previously described by Klett et al. Int Braz J Urol. 2022.  Eligibility criterium was an upper tract lesion ≥ 1 cm concerning for urothelial carcinoma.  Each tumor was biopsied four times: two biopsies for frozen section and two biopsies for final permanent section. Concordance of frozen and permanent section was assessed.

Results

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10 procedures performed on 10 patients between January of 2023 and June of 2023. Within the cohort there were 5 concordant pathology results, 2 disconcordant pathology results, 3 nondiagnostic frozen section interpretations. (Table 1) Permanent section yielded a diagnosis in all 10 patients. Final extirpative surgical pathology was available in 1/10 patients and was concordant. There were no complications related to biopsy.

 

Conclusion

Frozen pathology may yield concordant pathology results when compared to permanent pathology which could allow for intraoperative decision-making. Further work is needed to ontinue to improve frozen pathology diagnostic yield.

Funding

N/A

Co-Authors

Kevin Koo, MD
Mayo Clinic

Sharma Vidit, MD
Mayo Clinic

Potretzke Aaron, MD
Mayo Clinic