Critical evaluation of frozen section margins in head and neck cancer resections

Black, Candice C.; Marotti, Jonathan D.; Zarovnaya, Elena; Paydarfar, Joseph A.

doi:10.1002/cncr.22347

Cited by 110 publications

(107 citation statements)

References 91 publications

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“…4,5 There is no standard method for frozen section sampling, but the most common method is for the surgeon to, after removal of the gross tumor, take small samples of tissue from the defect cavity and send them to pathology for evaluation. 6,7 Other methods involve the surgeon sampling the margins directly from the main resection specimen or the pathologist receiving and sampling directly from it. These resection specimen margins may either be shave or radial sections taken from where the tumor is grossly closest to the margin.…”

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confidence: 99%

“…These resection specimen margins may either be shave or radial sections taken from where the tumor is grossly closest to the margin. 6 Shave margins are those in which small pieces of tissue are sampled from the periphery of a resection. This is done when the margins are not thought to harbor tumor and certainly, at least, are not grossly noted to harbor tumor.…”

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Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level

2011

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Frozen section analysis is an essential tool for assessing margins intra-operatively to assure complete resection. Many institutions evaluate surgical defect edge tissue provided by the surgeon after the main lesion has been removed. With the increasing use of transoral laser microsurgery, this method is becoming even more prevalent. We sought to evaluate error rates at our large academic institution and to see if sampling errors could be reduced by the simple method change of taking an additional third section on these specimens. All head and neck tumor resection cases from January 2005 through August 2008 with margins evaluated by frozen section were identified by database search. These cases were analyzed by cutting two levels during frozen section and a third permanent section later. All resection cases from August 2008 through July 2009 were identified as well. These were analyzed by cutting three levels during frozen section (the third a 'much deeper' level) and a fourth permanent section later. Error rates for both of these periods were determined. Errors were separated into sampling and interpretation types. There were 4976 total frozen section specimens from 848 patients. The overall error rate was 2.4% for all frozen sections where just two levels were evaluated and was 2.5% when three levels were evaluated (P ¼ 0.67). The sampling error rate was 1.6% for two-level sectioning and 1.2% for threelevel sectioning (P ¼ 0.42). However, when considering only the frozen section cases where tumor was ultimately identified (either at the time of frozen section or on permanent sections) the sampling error rate for two-level sectioning was 15.3 versus 7.4% for three-level sectioning. This difference was statistically significant (P ¼ 0.006). Cutting a single additional 'deeper' level at the time of frozen section identifies more tumor-bearing specimens and may reduce the number of sampling errors.

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Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level

2011

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“…The retreatment for positive margins after initial surgery is an effective form of treatment, but it is undesirable, and often not possible. Moreover, frozen sections are high priority, costly procedures that require multiple well-trained professionals [10]. In this study, all cases had surgical margins frozen and their pathology reports were free of neoplasia.…”

Section: Discussionmentioning

confidence: 98%

“…The accuracy of frozen section diagnosis is very close to the final diagnosis (>90%) and the usefulness of the procedure is well established [10,17]. The report of negative surgical margins is a prognostic factor of extreme importance.…”

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Analysis of surgical margins in oral cancer using in situ fluorescence spectroscopy

et al. 2014

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Early Oral Tongue Squamous Cell Carcinoma

Maxwell

Thompson

Brandwein-Gensler

et al. 2015

JAMA Otolaryngol Head Neck Surg

113

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IMPORTANCE Positive margins are associated with poor prognosis among patients with oral tongue squamous cell carcinoma (SCC). However, wide variation exists in the margin sampling technique. OBJECTIVE To determine the effect of the margin sampling technique on local recurrence (LR) in patients with stage I or II oral tongue SCC. DESIGN, SETTING, AND PARTICIPANTS A retrospective study was conducted from January 1, 1986, to December 31, 2012, in 5 tertiary care centers following tumor resection and elective neck dissection in 280 patients with pathologic (p)T1-2 pN0 oral tongue SCC. Analysis was conducted from June 1, 2013, to January 20, 2015. INTERVENTIONS In group 1 (n = 119), tumor bed margins were not sampled. In group 2 (n = 61), margins were examined from the glossectomy specimen, found to be positive or suboptimal, and revised with additional tumor bed margins. In group 3 (n = 100), margins were primarily sampled from the tumor bed without preceding examination of the glossectomy specimen. The margin status (both as a binary [positive vs negative] and continuous [distance to the margin in millimeters] variable) and other clinicopathologic parameters were compared across the 3 groups and correlated with LR. MAIN OUTCOMES AND MEASURES Local recurrence. RESULTS Age, sex, pT stage, lymphovascular or perineural invasion, and adjuvant radiation treatment were similar across the 3 groups. The probability of LR-free survival at 3 years was 0.9 and 0.8 in groups 1 and 3, respectively (P = .03). The frequency of positive glossectomy margins was lowest in group 1 (9 of 117 [7.7%]) compared with groups 2 and 3 (28 of 61 [45.9%] and 23 of 95 [24.2%], respectively) (P < .001). Even after excluding cases with positive margins, the median distance to the closest margin was significantly narrower in group 3 (2 mm) compared with group 1 (3 mm) (P = .008). The status (positive vs negative) of margins obtained from the glossectomy specimen correlated with LR (P = .007), while the status of tumor bed margins did not. The status of the tumor bed margin was 24% sensitive (95% CI, 16%-34%) and 92% specific (95% CI, 85%-97%) for detecting a positive glossectomy margin. CONCLUSIONS AND RELEVANCE The margin sampling technique affects local control in patients with oral tongue SCC. Reliance on margin sampling from the tumor bed is associated with worse local control, most likely owing to narrower margin clearance and greater incidence of positive margins. A resection specimen–based margin assessment is recommended.

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Critical evaluation of frozen section margins in head and neck cancer resections

Cited by 110 publications

References 91 publications

Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level

Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level

Analysis of surgical margins in oral cancer using in situ fluorescence spectroscopy

Early Oral Tongue Squamous Cell Carcinoma

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