Eugenie Du1, Thomas J Ow1,2, Yung-Tai Lo3, Adam Gersten2, Bradley A Schiff1, Andrew B Tassler1, Richard V Smith1,2. 1. Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, U.S.A. 2. Department of Pathology, Montefiore Medical Center; Albert Einstein College of Medicine, Bronx, New York, U.S.A. 3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: Previous studies report high-accuracy rates for intraoperative frozen sections, but reliability of frozen sections in predicting the ultimate final margin status is unknown. We compared frozen and permanent reads to identify risk factors for overall discrepancies between intraoperative and final margin status. STUDY DESIGN: Retrospective chart review. METHODS: Pathology reports of 437 surgical resections between 2010 and 2013 were retrospectively reviewed. A total of 253 cases, generating 1,109 individual specimens, met inclusion criteria. Patient demographics, treatment, recurrence, and survival, as well as pathology data pertaining to the specimen, were recorded. RESULTS: Frozen read accuracy was 96.7% (83.1% sensitivity, 97.9% specificity) relative to permanent evaluation. However, 4.3% of cases had a final positive margin not detected by frozen section; 17.8% had a close margin not detected by frozen section. In eight of 11 cases with missed positive margins, the involved margin was never sampled intraoperatively. Cases where intraoperative margins were only taken from surrounding tissue had a higher risk of missing a close or positive final margin when compared to cases where some or all margins were taken from the specimen (odds ratio = 5.05, 95% confidence interval [2.31, 11.07], P <0.0001). Disease subsite, risk score, prior radiation, staging, and p16 expression were not significantly associated with the likelihood of missing a close or positive final margin. CONCLUSION: Individual frozen section reads are highly accurate. However, negative intraoperative margins do not guarantee margin-negative resections. The process of selecting representative margins for intraoperative analysis, specifically the practice of sampling the resection bed, should be refined. LEVEL OF EVIDENCE: N/A. Laryngoscope, 126:1768-1775, 2016.
OBJECTIVES/HYPOTHESIS: Previous studies report high-accuracy rates for intraoperative frozen sections, but reliability of frozen sections in predicting the ultimate final margin status is unknown. We compared frozen and permanent reads to identify risk factors for overall discrepancies between intraoperative and final margin status. STUDY DESIGN: Retrospective chart review. METHODS: Pathology reports of 437 surgical resections between 2010 and 2013 were retrospectively reviewed. A total of 253 cases, generating 1,109 individual specimens, met inclusion criteria. Patient demographics, treatment, recurrence, and survival, as well as pathology data pertaining to the specimen, were recorded. RESULTS: Frozen read accuracy was 96.7% (83.1% sensitivity, 97.9% specificity) relative to permanent evaluation. However, 4.3% of cases had a final positive margin not detected by frozen section; 17.8% had a close margin not detected by frozen section. In eight of 11 cases with missed positive margins, the involved margin was never sampled intraoperatively. Cases where intraoperative margins were only taken from surrounding tissue had a higher risk of missing a close or positive final margin when compared to cases where some or all margins were taken from the specimen (odds ratio = 5.05, 95% confidence interval [2.31, 11.07], P <0.0001). Disease subsite, risk score, prior radiation, staging, and p16 expression were not significantly associated with the likelihood of missing a close or positive final margin. CONCLUSION: Individual frozen section reads are highly accurate. However, negative intraoperative margins do not guarantee margin-negative resections. The process of selecting representative margins for intraoperative analysis, specifically the practice of sampling the resection bed, should be refined. LEVEL OF EVIDENCE: N/A. Laryngoscope, 126:1768-1775, 2016.
Keywords:
Frozen sections/utilization; carcinoma; head and neck neoplasm/pathology; head and neck neoplasms/surgery; intraoperative care; squamous cell
Authors: Guolan Lu; James V Little; Xu Wang; Hongzheng Zhang; Mihir R Patel; Christopher C Griffith; Mark W El-Deiry; Amy Y Chen; Baowei Fei Journal: Clin Cancer Res Date: 2017-06-13 Impact factor: 12.531
Authors: Maxime D Slooter; Henricus J M Handgraaf; Martin C Boonstra; Lily-Ann van der Velden; Shadhvi S Bhairosingh; Ivo Que; Lorraine M de Haan; Stijn Keereweer; Pieter B A A van Driel; Alan Chan; Hisataka Kobayashi; Alexander L Vahrmeijer; Clemens W G M Löwik Journal: Oral Oncol Date: 2018-01-09 Impact factor: 5.337
Authors: Rebecca C Hoesli; Daniel A Orringer; Jonathan B McHugh; Matthew E Spector Journal: Otolaryngol Head Neck Surg Date: 2017-04-11 Impact factor: 3.497
Authors: Michael M Li; Sidharth V Puram; Dustin A Silverman; Matthew O Old; James W Rocco; Stephen Y Kang Journal: Ann Surg Oncol Date: 2019-08-05 Impact factor: 5.344
Authors: Paula Demétrio de Souza França; Navjot Guru; Sheryl Roberts; Susanne Kossatz; Christian Mason; Marcio Abrahão; Ronald A Ghossein; Snehal G Patel; Thomas Reiner Journal: Sci Rep Date: 2020-07-07 Impact factor: 4.379
Authors: Martin Halicek; James D Dormer; James V Little; Amy Y Chen; Larry Myers; Baran D Sumer; Baowei Fei Journal: Cancers (Basel) Date: 2019-09-14 Impact factor: 6.639