The Journal of Urology
Volume 179, Issue 2 , Pages 461-467, February 2008

Trends in the Use of Gross and Frozen Section Pathological Consultations During Partial or Radical Nephrectomy for Renal Cell Carcinoma

  • David C. Miller

      Affiliations

    • Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
    • Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California
    • ,
  • Rajal B. Shah

      Affiliations

    • Departments of Pathology and Urology, University of Michigan Medical School, Ann Arbor, Michigan
    • ,
  • Aron Bruhn

      Affiliations

    • Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
    • ,
  • Rodger Madison

      Affiliations

    • RAND Corp., Santa Monica, California
    • ,
  • Christopher S. Saigal

      Affiliations

    • Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
    • RAND Corp., Santa Monica, California
    • Corresponding Author InformationCorrespondence: Department of Urology, University of California-Los Angeles, Box 951738, Los Angeles, California 90095-1738 (telephone: 310-206-8183; FAX: 310-206-5343).
    • ,
  • Urologic Diseases in America Project

Received 29 May 2007 published online 12 December 2007.

Purpose

There is no consensus regarding the role of intraoperative pathological consultation during kidney cancer surgery. Accordingly intraoperative pathological consultation use is susceptible to variation based on nonclinical factors. We explored this hypothesis by evaluating national trends in the use of intraoperative pathological consultation during radical or partial nephrectomy with time, across regions, and by patient and provider characteristics.

Materials and Methods

Using linked Surveillance, Epidemiology and End Results-Medicare data we identified a cohort of patients who underwent partial or radical nephrectomy from 1991 to 2002. In each case we ascertained corresponding Medicare claims for gross and/or frozen section intraoperative pathological consultation. We assessed variations in the use of intraoperative pathological consultation by year of treatment and geographic region as well as by patient and provider characteristics.

Results

We identified 7,507 cases treated with partial (600 or 8.0%) or radical (6,907 or 92.0%) nephrectomy from 1991 through 2002. Of cases treated with radical nephrectomy 744 (10.8%) and 843 (12.2%) received gross and frozen section intraoperative pathological consultation, respectively. Of cases treated with partial nephrectomy 67 (11.2%) had an intraoperative gross consultation and 323 (53.8%) had a frozen section evaluation. Use of intraoperative pathological consultation (gross or frozen section) during partial and radical nephrectomy varied based on patient demographics, United States Census region, and Surveillance, Epidemiology and End Results registry (p <0.05). Intraoperative pathological consultation during radical nephrectomy differed by year of treatment (p <0.05). Intraoperative pathological consultation use also varied based on provider characteristics (p <0.05).

Conclusions

Intraoperative pathological consultation use during kidney cancer surgery varies with time, across geographic regions and based on patient demographics and broadly defined provider characteristics. These data provide context for future studies seeking to refine the use of intraoperative pathological consultation in this clinical setting.

Key Words: kidney, kidney neoplasms, pathology, surgical, frozen sections, trends

Abbreviations and Acronyms: CMS, Centers for Medicare and Medicaid Services, CPT, Current Procedural Terminology, IPC, intraoperative pathological consultation, SEER, Surveillance, Epidemiology and End Results

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 Study received approval from the University of California-Los Angeles institutional review board.

 Supported by the National Institute of Diabetes, Digestive and Kidney Diseases, National Cancer Institute NIH-1-F32 CA123819-01 (DCM), American Cancer Society PF CPHPS-112124 (DCM) and the American Urological Association Foundation Research Scholar Program (DCM).

PII: S0022-5347(07)02541-4

doi:10.1016/j.juro.2007.09.041

The Journal of Urology
Volume 179, Issue 2 , Pages 461-467, February 2008

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