Robot-assisted radical prostatectomy : multiparametric MR imaging-directed intraoperative frozen-section analysis to reduce the rate of positive surgical margins

Purpose To investigate whether use of multiparametric magnetic resonance (MR) imaging-directed intraoperative frozen-section ( IFS intraoperative frozen section ) analysis during nerve-sparing robot-assisted radical prostatectomy reduces the rate of positive surgical margins. Materials and Methods This retrospective analysis of prospectively acquired data was approved by an institutional ethics committee, and the requirement for informed consent was waived. Data were reviewed for 134 patients who underwent preoperative multiparametric MR imaging (T2 weighted, diffusion weighted, and dynamic contrast-material enhanced) and nerve-sparing robot-assisted radical prostatectomy, during which IFS intraoperative frozen section analysis was used, and secondary resections were performed when IFS intraoperative frozen section results were positive for cancer. Control patients (n = 134) matched for age, prostate-specific antigen level, and stage were selected from a pool of 322 patients who underwent nerve-sparing robot-assisted radical prostatectomy without multiparametric MR imaging and IFS intraoperative frozen section analysis. Rates of positive surgical margins were compared by means of the McNemar test, and a multivariate conditional logistic regression model was used to estimate the odds ratio of positive surgical margins for patients who underwent MR imaging and IFS intraoperative frozen section analysis compared with control subjects. Results Eighteen patients who underwent MR imaging and IFS intraoperative frozen section analysis underwent secondary resections, and 13 of these patients were found to have negative surgical margins at final pathologic examination. Positive surgical margins were found less frequently in the patients who underwent MR imaging and IFS intraoperative frozen section analysis than in control patients (7.5% vs 18.7%, P = .01). When the differences in risk factors are taken into account, patients who underwent MR imaging and IFS intraoperative frozen section had one-seventh the risk of having positive surgical margins relative to control patients (adjusted odds ratio: 0.15; 95% confidence interval: 0.04, 0.61). Conclusion The significantly lower rate of positive surgical margins compared with that in control patients provides preliminary evidence of the positive clinical effect of multiparametric MR imaging-directed IFS intraoperative frozen section analysis for patients who undergo prostatectomy.