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. 2020 Oct;77(4):539-547.
doi: 10.1111/his.14184. Epub 2020 Sep 3.

Intraoperative assessment and reporting of radical prostatectomy specimens to guide nerve-sparing surgery in prostate cancer patients (NeuroSAFE)

Margaretha A van der Slot  1   2 , Michael A den Bakker  1   2 , Sjoerd Klaver  1   3 , Mike Kliffen  1   2 , Martijn B Busstra  1   4 , John B W Rietbergen  1   5 , Melanie Gan  1   3 , Karen E Hamoen  1   2 , Leo M Budel  1   2 , Natascha N T Goemaere  1   2 , Chris H Bangma  1   4 , Jozien Helleman  4 , Monique J Roobol  4 , Geert J L H van Leenders  1   6
Affiliations

Intraoperative assessment and reporting of radical prostatectomy specimens to guide nerve-sparing surgery in prostate cancer patients (NeuroSAFE)

Margaretha A van der Slot et al. Histopathology. 2020 Oct.

Abstract

Aims: Radical prostatectomy for prostate cancer is frequently complicated by urinary incontinence and erectile dysfunction. Nerve-sparing surgery reduces the risk of postoperative complications and can be optimised by the use of intraoperative frozen sections of the adjacent neurovascular structure (NeuroSAFE). The aims of this study were to evaluate the pathological outcomes of the NeuroSAFE technique and to develop a comprehensive algorithm for intraoperative clinical decision-making.

Methods and results: Between September 2018 and May 2019, 491 NeuroSAFE procedures were performed in 258 patients undergoing radical prostatectomy; 74 of 491 (15.1%) NeuroSAFE specimens had positive surgical margins. As compared with the corresponding paraffin sections, NeuroSAFE had a positive predictive value and negative predictive value of 85.1% and 95.4%, respectively. In 72.2% of secondary neurovascular bundle resections prompted by a NeuroSAFE positive surgical margin, no tumour was present. These cases more often had a positive surgical margin of ≤1 mm (48.7% versus 20.0%; P = 0.001) and only one positive slide (69.2% versus 33.3%; P = 0.008). None of the nine patients with Gleason pattern 3 at the surgical margin, a positive surgical margin length of ≤1 mm and one positive slide had tumour in the secondary resection.

Conclusions: This study provides a systematic reporting template for pathological intraoperative NeuroSAFE evaluation, supporting intraoperative clinical decision-making and comparison between prostate cancer operation centres.

Keywords: NeuroSAFE; frozen section; prostate cancer; prostatectomy; surgical margin.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic overview of NeuroSAFE procedures and secondary neurovascular bundle resections.
Figure 2
Figure 2
Frozen sections (A,C) and corresponding paraffin sections (B,D) of two NeuroSAFE slices. A,B, Both frozen and corresponding paraffin sections have positive surgical margins with tumour cells into the ink (concordant). C,D, A frozen section was called surgical margin‐negative, whereas the corresponding paraffin section showed a positive surgical margin (discordant). Haematoxylin and eosin.
See this image and copyright information in PMC

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