Assessment of frozen section margin analysis during olfactory neuroblastoma surgery

Ishii, Masaru; Bishop, Justin A.; Gallia, Gary L.

doi:10.1002/lary.26496

Cited by 7 publications

(10 citation statements)

References 29 publications

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“…On permanent histopathological analysis, however, we found microscopic foci of tumor cells in 35% of cases. In a recently published study, 16 we examined the performance of frozen section analysis in ONB and found a sensitivity of 0.89, a specificity of 0.96, an accuracy of 0.95, a positive predictive value of 0.86, a negative predictive value of 0.97, a likelihood ratio positive of 24.38, a likelihood ratio negative of 0.11, and a prevalence of 0.20. Based on these metrics and the number of samples we take per case, which in this study averaged 25.3, the finding of falsely negative frozen margins in 35% of cases is not surprising.…”

Section: Discussionmentioning

confidence: 99%

Endonasal endoscopic resection of olfactory neuroblastoma: an 11-year experience

Gallia¹,

Asemota²,

Blitz

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Olfactory neuroblastoma (ONB) is a rare malignant neoplasm of the sinonasal cavity. Surgery has been and remains a mainstay of treatment for patients with this tumor. Open craniofacial resections have been the treatment of choice for many decades. More recently, experience has been growing with endoscopic approaches in the management of patients with ONB. The object of this study is to report the authors' experience over the past 11 years with ONB patients treated with purely endonasal endoscopic techniques. METHODS The authors performed a retrospective chart review of 20 consecutive patients with ONB who underwent a completely endonasal endoscopic approach for an oncological tumor resection at their institution between January 2006 and January 2017. Patient demographics, tumor stage, pathological grade, frozen section analysis, permanent margin assessment, perioperative complications, postoperative therapy, length of follow-up, and outcomes at last follow-up were collected and analyzed. RESULTS Eighteen patients presented with newly diagnosed disease, with a modified Kadish stage of A in 2 cases, B in 3, C in 11, and D in 2. Two patients presented with recurrent tumors. An average of 25.3 specimens per patient were examined by frozen section analysis. Although analysis of intraoperative frozen section margins was negative in all but 1 case, microscopic foci of tumor were found in 7 cases (35%) on permanent histopathological analysis. Perioperative complications occurred in 7 patients (35%) including 1 patient who developed a cerebrospinal fluid leak; there were no episodes of meningitis. All but 1 patient received postoperative radiotherapy, and 5 patients received postoperative chemotherapy. With a mean follow-up of over 5 years, 19 patients were alive and 1 patient died from an unrelated cause. There were 2 cases of tumor recurrence. The 5-year overall, disease-specific, and recurrence-free survival rates were 92.9%, 100%, and 92.9%, respectively. CONCLUSIONS The current results provide additional evidence for the continued use of endoscopic procedures in the management of this malignancy.

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Section: Discussionmentioning

confidence: 99%

Endonasal endoscopic resection of olfactory neuroblastoma: an 11-year experience

Gallia¹,

Asemota²,

Blitz

et al. 2019

Journal of Neurosurgery

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“…The diagnostic performance of IFSH compared with FFPE is more widely described than in other head and neck sites owing to the relative rarity of sinonasal and skull base tumors. The reported accuracy of IFSH varies considerably but is typically lower for sinonasal and skull base neoplasms compared with other head and neck sites 2,5,7–9 . In addition, extrapolating results from the head and neck literature to sinonasal pathologies is problematic due to the different histopathologies encountered.…”

Section: Discussionmentioning

confidence: 99%

“…esthesioneuroblastoma, with a sensitivity, specificity, and accuracy of 89%, 96%, and 95%, respectively, however, similar to our study the sensitivity is less than 90%. 9 Interestingly, in another study of endoscopically resected esthesioneuroblastoma by the same author, 1 IFSH specimen (5% of cases) was positive initially but on FFPE 10 IFSH specimens were positive (35% of cases), which they attributed to the to the high number of IFSH samples taken per case intraoperatively. 11 In our study, the sensitivity for the "other" group was 94.4%; however, this group is a collection of rare pathologies, which limits meaningful interpretation.…”

Section: Diagnostic Performance and Utility Of Ifshmentioning

confidence: 96%

“…The reported accuracy of IFSH varies considerably but is typically lower for sinonasal and skull base neoplasms compared with other head and neck sites. 2,5,[7][8][9] In addition, extrapolating results from the head and neck literature to sinonasal pathologies is problematic due to the different histopathologies encountered. In a large series by Gandour-Edwards et al 7 encompassing a variety of head and neck surgeries an overall error rate of 2.1% for IFSH was reported.…”

Section: Diagnostic Performance and Utility Of Ifshmentioning

confidence: 99%

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Understanding frozen section histopathology in Sinonasal and anterior skull base malignancy and proposed reporting guidelines

Mclean,

Fitzgerald,

Eagan

et al. 2023

Journal of Surgical Oncology

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BackgroundIntraoperative frozen section histopathology (IFSH) in sinonasal and skull base surgery although widely used is not well studied.MethodsWe reviewed a database of sinonasal and anterior skull base tumors, between 1973 and 2019, and identified 312 suitable operative cases. Clinicopathologic data was collected and analyzed, in addition to descriptive data for histopathological reports classified as “ambiguous,” or “limited/insufficient‐quality/quantity.”ResultsOverall, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for IFSH were 90.2%, 97.5%, 94.2%, 95.6%, and 95.2%, respectively. IFSH for adenocarcinoma, salivary carcinoma, and SCC all demonstrated a better clinical utility with a sensitivity of 90% or greater, while it was less than 90% for esthesioneuroblastoma, melanoma, and sarcoma. Other factors such as unclear reporting, poor quality specimens, or limited quality specimens were shown to lower diagnostic performance. Based on limitations identified, we proposed a novel IFSH reporting algorithm to improve IFSH in sinonasal and skull base surgery.ConclusionsIFSH is an accurate and clinically useful technique in sinonasal and skull base surgery patients; however, limitations exist.

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“…After the transfer, prior to the sectioning, several inevitable factors can lead to the creation of frozen artifacts [23]. These frozen section artifacts result in a decrease of resolution of the microscopic images and, therefore, it is important to recognize these artifacts to obtain a correct interpretation [23,24].…”

Section: Current State Of Tumor Diagnosticsmentioning

confidence: 99%

Mass Spectrometry-Based Intraoperative Tumor Diagnostics

et al. 2019

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In surgical oncology, decisions regarding the amount of tissue to be removed can have important consequences: the decision between preserving sufficient healthy tissue and eliminating all tumor cells is one to be made intraoperatively. This review discusses the latest technical innovations for a more accurate tumor margin localization based on mass spectrometry. Highlighting the latest mass spectrometric inventions, real-time diagnosis seems to be within reach; focusing on the intelligent knife, desorption electrospray ionization, picosecond infrared laser and MasSpec pen, the current technical status is evaluated critically concerning its scientific and medical practice.

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Assessment of frozen section margin analysis during olfactory neuroblastoma surgery

Abstract: NA. Laryngoscope, 127:1735-1741, 2017.

Cited by 7 publications

References 29 publications

Endonasal endoscopic resection of olfactory neuroblastoma: an 11-year experience

Endonasal endoscopic resection of olfactory neuroblastoma: an 11-year experience

Understanding frozen section histopathology in Sinonasal and anterior skull base malignancy and proposed reporting guidelines

Mass Spectrometry-Based Intraoperative Tumor Diagnostics

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