Frozen section analysis for organ-conserving surgery in penile cancer: Assessing oncological outcomes and trends of local recurrence

Ellul, Thomas; Grice, Peter; Mainwaring, Anna; Bullock, Nicholas; Shanahan, Alexis; Cave, D; Dormer, John; Harrison, Rebecca; Brown, Gareth; Younis, Ayman; Bose, P.; Goddard, Jonathan Charles; Summerton, Duncan J.

doi:10.1177/2051415820903192

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…A diagnosis of cancer was confirmed in all cases by biopsy. The use of intraoperative frozen sections ensured that oncological clear margins were achieved when treating the primary [ 8 ]. All data collected on the MRI report with the corresponding final histopathology was anonymised, with patient-identifiable information removed before being reviewed and analysed by the researcher.…”

Section: Methodsmentioning

confidence: 99%

Does MRI Have a Role in the Preoperative Staging of Penile Cancer?

Iqbal,

Shendy,

McClune

et al. 2024

Cureus

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Background Penile cancer is a rare malignancy usually requiring surgery to achieve oncological control of the primary tumour but often at the expense of functional length. The presenting stage of the primary is a crucial factor in determining the most appropriate surgical procedure. Accurate preoperative staging is essential, and current modalities include clinical and radiological assessment. Clinical staging can, however, be hampered by patient body habitus and unreliable for more advanced T4 tumours, whereas radiological staging allows for more detailed identification of tissue planes and tumour involvement. There is no clear consensus on the preferred imaging technique, although, in the current European Association of Urology penile cancer guidelines, MRI is recommended with the use of ultrasound when MRI is not available. It was recommended that having the penis in an erect state by the administration of intra-cavernosal prostaglandin gave a more detailed picture enabling a greater predictor of corporal involvement. Recent studies have, however, suggested that there may be no such advantage. Methodology A retrospective review was conducted of all patients who underwent surgery for penile cancer comparing the preoperative MRI stage with the final pathological stage between July 2009 and June 2023. In addition to the MRI, patients were given an intra-cavernosal injection of prostaglandin E1 to induce tumescence unless otherwise indicated. All imaging was reported by a single consultant uro-radiologist with surgery undertaken by a single surgeon and pathology reviewed through the supra-regional penile multidisciplinary team. Results A total of 136 penile cancer patients were included in the review. Within this cohort, 98 patients had an MRI without intra-cavernosal prostaglandin and the number who had Ta, T1, T2, T3 and T4 histopathological stages was 3, 31, 45, 18, and 1, respectively. The preoperative MRI stage had a low agreement with the final histological stage for early tumours, with sensitivities and specificity of 35% and 97% for T1 and 56% and 80% for T2, respectively. Sensitivity and specificity increased for cavernosal involvement at 83% and 95%, respectively. In addition, a further 38 patients had an MRI in conjunction with an injection of prostaglandin E1 which failed to show any diagnostic improvement in sensitivity or specificity in the preoperative MRI stage. Conclusions The use of MRI as a preoperative modality for staging penile cancer performs best for identifying tumour involvement of the cavernosal bodies. Performing the MRI with the penis erect with the use of an intra-cavernosal injection did not offer any additional benefit in accurately staging penile cancer.

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Section: Methodsmentioning

confidence: 99%

Does MRI Have a Role in the Preoperative Staging of Penile Cancer?

Iqbal,

Shendy,

McClune

et al. 2024

Cureus

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“…However, this examination is labour intensive, requiring an available histopathologist, is time consuming, and is not 100% accurate in its assessment. A recent study has suggested that the use of FFS may reduce recurrence rates [11,12].…”

Section: New Ways Of Determining Resection Marginsmentioning

confidence: 99%

Update on penile sparing surgery for penile cancer

Anastasiadis

Ayres²,

Watkin³

2021

Current Opinion in Urology

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Purpose of reviewPenile sparing surgery (PSS) is considered the standard of care in penile cancer where appropriate, as preservation of the penis may enable the patient to maintain urinary and sexual function. This review will focus on the latest developments over the past two years. Recent findingsIn this review, we discuss the latest findings in oncological outcomes in PSS, specifically glansectomy. We also introduce technology that may be useful in improving the precision of surgical resection margins in PSS. Finally, we consider the value of patient-reported outcome measures (PROMs) and consider how research in this area can be improved. SummaryA recent study has found a correlation between local recurrences (LR) and worse overall and cancerspecific survival in glansectomy, which challenges the belief that LR do not confer worse oncological outcomes. Despite numerous studies evaluating PROMs in penile cancer/PSS, few of these studies provide quality evidence of the 'supportive care needs'. A shift in research is required to identify those men at most risk of distress and to identify ways to support men diagnosed with penile cancer.

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