Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles

Abstract

ConclusionsThere is no homogeneity in prostate sampling for FS analysis, although most recent evidence is moving toward a systematic sampling of the entire NS area. The management of a PSM is variable and can be affected by the sampling strategy (difficult localisation of the persisting tumour at the NVB). The difficult identification of the exact soft tissue location contiguous to a PSM could be considered as the critical point of FS analysis and of spared-NVB management.

Evaluation of image‐based prognostic parameters of post‐prostatectomy urinary incontinence: A literature review

“…DTI shows promise, and the ability to detect PNFs in vivo might complement the novel surgical technique of NeuroSAFE, which incorporates analysis of frozen section prostatic samples at the edges of the prostate perioperatively to help preserve nerve fiber integrity while ensuring clear margins. 22 However, DTI acquisition is timeconsuming and expertise is required for interpretation, and any additional scanning time needs to be balanced against MRI availability and throughput of patients. 58,59 US is another modality that has been utilized for assessment of the male pelvic floor.…”

“…[19][20][21] As a result, innovative surgical techniques have been introduced to limit postoperative complications, including unilateral nerve-sparing approaches or adoption of "NeuroSAFE" intraoperative frozen section examination, particularly in patients at higher clinical risk, or when MRI is equivocal. [22][23][24] Despite these improvements in imaging quality and surgical techniques, PPUI remains a major functional complication in patients undergoing RP and is present in up to 6-20% of patient at 1-year post-surgery. 25 The ability to predict patients at higher risk of developing such complications might help select patients for other management strategies for their prostate cancer or enable early postoperative interventions to minimize the impacts on quality of life.…”

How molecular imaging will enable robotic precision surgery

“…The introduction of frozen section histology has been a significant step towards highspeed pathological tissue analysis, which can be performed within the time frame of the surgery itself. Not only has this been widely applied during lymphatic mapping, where it is recommended in almost all indications besides breast cancer and melanoma [192], it is also routinely used in primary tumor resection wherever big margins are not possible to avoid functional or aesthetic side effects, e.g., in skin cancer [193], breast cancer [194], head and neck cancer [195], and prostate cancer [196,197]. However, having a pathologist available for intraoperative assessments is a luxury most hospitals can not afford.…”

Digital frozen section of the prostate surface during radical prostatectomy: a novel approach to evaluate surgical margins

“…Tracking a positive SM on the spared NVB represents an unaddressed issue of the NeuroSAFE approach. Only 23–42% of NeuroSAFE series had positive secondary resections at the final pathological examination, showing that the majority of re‐resections were not actually justified [8]. Preservation of tissue integrity for the conventional circumferential H&E analysis after a previous FCM en‐face evaluation of a Mohs section.…”