Frozen section evaluation in head and neck oncosurgery: an initial experience in a tertiary cancer center

Abstract

Objective: Frozen section evaluation is routinely used by oncosurgeons across specialties for rapid assessment of the presence of tumor in any tissue and its most common use is in surgical margins. Today, the use of intraoperative frozen-section evaluation of surgical margins is an accepted and frequent practice in head and neck oncology. This study aims to determine the efficacy and accuracy of frozen sections in head and neck cancer patients and compare the results with the respective paraffin sections and also to analyze the reasons for any disparity between them. Material and Method:A retrospective study was conducted to evaluate efficacy and accuracy of frozen section in head and neck cancer of 265 patients, treated at a tertiary cancer centre hospital between January 2013 to December 2014.Results: Out of 265 cases, it was found that 12.6% of these sections showed true positivity, 6.3% false positivity, 2.9% false negativity and 78.2% true negativity. The study also shows a sensitivity of 82.05% and specificity of 96.46%. Conclusion:Our study shows that intraoperative frozen section reports are specific and highly sensitive. We recommend a minimum of 3-4 sections, optimum cryostat temperature, good section thickness and quality staining for a good concordance rate.

A Novel Technique for Intraoperative Assessment of Surgical Margin Using Lugols Iodine and Frozen Section Methods in Oral Squamous Cell Carcinoma

“…The age of the patients in our study ranged from 37-67 years, which was in accordance with previous studies by Kumar et al, and Bin Ahmed et al, [51,52]. Overall male to female ratio was 2.3:1, which was similar in studies by Pandey et al, [11] and Bin Ahmed et al, [52].…”

Analysis of intraoperative frozen section consultations and audit of accuracy: a two year experience in a tertiary care multispeciality hospital in India

“…15 Studies have shown accuracy rate on FS for margin status in oral cancers varying from 71.3% to 97.5%. 3,16 In this study centre no discordant case was reported from oral cavity during the period of audit. Most of the false negative cases on FS for margins in head and neck surgeries are reported due to staining issues, section folding, thick sections and/or lack of pathologist's experience as per related studies.…”

Association of Intraoperative Frozen Section Controls With Improved Margin Assessment During Transoral Robotic Surgery for Human Papillomavirus–Positive Oropharyngeal Squamous Cell Carcinoma

“…A study by Layfield et al of 1796 pairs of frozen and permanent sections found that discordance existed in only 3.1% of pairs. Other studies have concurred with these findings, with multiple articles reporting the accuracy and specificity of frozen margin analysis as above 90% . Reports of sensitivity are more variable, ranging from 47% to 99% …”

“…In the resection of head and neck tumors, margin assessment is generally regarded as one of the critical predictors of overall and disease-free survival . Given that complete surgical resection is an important prognostic factor, intraoperative assessment of frozen tumor margins is a common practice . Baddour et al noted that the practice of intraoperative frozen section analysis in resections of head and neck cancer displays high diagnostic accuracy, with more than 95% concurrence between intraoperative sectioning and final pathologic diagnosis.…”

“…Other studies have concurred with these findings, with multiple articles reporting the accuracy and specificity of frozen margin analysis as above 90% . Reports of sensitivity are more variable, ranging from 47% to 99% …”