Intraoperative Consultation for Prostate Tumors: Challenges and Implications for Treatment

Abstract

Intraoperative pathologic consultation provides critical information that determines immediate diagnostic decision making for optimal patient care. The most frequent indications for intraoperative consultation during prostate surgery include assessment of surgical margin status and pelvic lymph nodes during radical prostatectomy. Small biopsy specimens from the apex of the prostate, bladder neck, and/or lateral area of the neurovascular bundle are often submitted for frozen section assessment of surgical margins. Benign prostatic glands may be seen at the apex with associated skeletal muscle and at the bladder neck. Cauterized nests of nerve and ganglion cells may have prominent nucleoli similar to those seen in prostate cancer cells. Gross examination of lymph nodes may suffice in low-risk patients, whereas, frozen section assessment of nodal status is usually required in high-risk patients. Other common pitfalls in the frozen section diagnosis include various types of artifacts such as thermal injury, crush artifact, and freeze artifact. Recognizing these artifacts as well as reviewing previous biopsy materials from the same patients prior to the intraoperative consultation is always a key to adequate interpretation of the specimens.