Frozen section: guiding the hands of surgeons?

McIntosh, Eleanor R.; Harada, Shuko; Drwiega, Joseph C.; Brandwein-Gensler, Margaret; Gordetsky, Jennifer B.

doi:10.1016/j.anndiagpath.2015.07.004

Cited by 20 publications

(11 citation statements)

References 13 publications

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“…McIntosh et al described that intraoperative control of the resection margins is more frequently performed in head and neck surgery than in other surgical specialties . According to the current guidelines of the AJCC, specimen‐driven intraoperative assessment is the standard of care .…”

Section: Discussionmentioning

confidence: 99%

“…In order to control resection margins, intraoperative assessment based on the frozen section procedure is available. Of all surgical disciplines, intraoperative assessment of the resection margins is most often used in head and neck surgery . Except for Mohs surgery, the role of the frozen section procedure in other surgical fields is limited.…”

Section: Introductionmentioning

confidence: 99%

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Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

et al. 2019

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Background Specimen‐driven intraoperative assessment of the resection margins provides immediate feedback if an additional excision is needed. However, relocation of an inadequate margin in the wound bed has shown to be difficult. The objective of this study is to assess a reliable method for accurate relocation of inadequate tumor resection margins in the wound bed after intraoperative assessment of the specimen. Methods During oral cavity cancer surgery, the surgeon placed numbered tags on both sides of the resection line in a pair‐wise manner. After resection, one tag of each pair remained on the specimen and the other tag in the wound bed. Upon detection of an inadequate margin in the specimen, the tags were used to relocate this margin in the wound bed. Results The method was applied during 80 resections for oral cavity cancer. In 31 resections an inadequate margin was detected, and based on the paired tagging an accurate additional resection was achieved. Conclusion Paired tagging facilitates a reliable relocation of inadequate margins, enabling an accurate additional resection during the initial surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

et al. 2019

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“…Intraoperative frozen section (FS) consultation is a valuable tool in surgical oncology to rapidly obtain data that will affect the patient’s operative plan. Most commonly, FS is used to evaluate margin status, identify benign versus malignant tissue and lymph nodes, or classify tumors [ 1 ]. FS consultation is particularly important in thoracic oncology, where almost half of patients undergo pulmonary resection for a suspicious lung mass without a pre-operative tissue biopsy [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Molecular imaging can identify the location to perform a frozen biopsy during intraoperative frozen section consultation

et al. 2021

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Background Intraoperative frozen section (FS) consultation is an important tool in surgical oncology that suffers from sampling error because the pathologist does not always know where to perform a biopsy of the surgical specimen. Intraoperative molecular imaging is a technology used in the OR to visualize lesions during surgery. We hypothesized that molecular imaging can address this pathology challenge in FS by visualizing the cancer cells in the specimen in the pathology suite. Here, we report the development and validation of a molecular-imaging capable cryostat called Smart-Cut. Methods A molecular imaging capable cryostat prototype was developed and tested using a murine model. Tumors grown in mice were targeted with a NIR contrast agent, indocyanine green (ICG), via tail vein injection. Tumors and adjacent normal tissue samples were frozen sectioned with Smart-Cut. Fluorescent sections and non-fluorescent sections were prepared for H&E and fluorescent microscopy. Fluorescent signal was quantified by tumor-to-background ratio (TBR). NIR fluorescence was tested in one patient enrolled in a clinical trial. Results The Smart-Cut prototype has a small footprint and fits well in the pathology suite. Fluorescence imaging with Smart-Cut identified cancerous tissue in the specimen in all 12 mice. No false positives or false negatives were seen, as confirmed by H&E. The mean TBR in Smart-Cut positive tissue sections was 6.8 (SD±3.8). In a clinical application in the pathology suite, NIR imaging identified two lesions in a pulmonary resection specimen, where traditional grossing only identified one. Conclusion Molecular imaging can be integrated into the pathology suite via the Smart-Cut device, and can detect cancer in frozen tissue sections using molecular imaging in a murine model.

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“…For the detection of inadequate margins during OCSCC surgery, this defect-driven frozen section procedure has been shown to have low sensitivity (5)(6)(7)(8)(9). Moreover, this procedure is time-consuming and only a limited number of tissue samples can be examined, leading to sampling error, and resulting in underestimation of inadequate margins (10)(11)(12)(13)(14)(15). Furthermore, the defect-driven frozen section procedure cannot provide the exact length of resection margins (in millimeters); it can only indicate the presence of tumor-positive margins.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Assessment of the Resection Specimen Facilitates Achievement of Adequate Margins in Oral Carcinoma

et al. 2020

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BackgroundInadequate resection margins in oral cavity squamous cell carcinoma have an adverse effect on patient outcome. Intraoperative assessment provides immediate feedback enabling the surgeon to achieve adequate resection margins. The goal of this study was to evaluate the value of specimen-driven intraoperative assessment by comparing the margin status in the period before and the period after the introduction of specimen-driven assessment as a standard of care (period 2010–2012 vs period 2013–2017).MethodsA cohort of patients surgically treated for oral squamous cell carcinoma at the Erasmus MC Cancer Institute, Rotterdam, between 2010–2012 was studied retrospectively and compared to results of a prospectively collected cohort between 2013–2017. The frequency, type and results of intraoperative assessment of resection margins were analyzed.ResultsOne hundred seventy-four patients were included from 2010–2012, 241 patients were included from 2013–2017. An increase in the frequency of specimen-driven assessment was seen between the two periods, from 5% in 2010–2012 to 34% in 2013–2017. When performing specimen-driven assessment, 16% tumor-positive resection margins were found in 2013–2017, compared to 43% tumor-positive resection margins overall in 2010–2012. We found a significant reduction of inadequate resection margins for specimen-driven intraoperative assessment (p < 0.001). Also, tumor recurrence significantly decreased, and disease-specific survival improved when performing specimen-driven intraoperative assessment.ConclusionsSpecimen-driven intraoperative assessment improves resection margins and consequently, the outcome of oral cancer patients. We advocate this method as standard of care.

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Frozen section: guiding the hands of surgeons?

Cited by 20 publications

References 13 publications

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

Molecular imaging can identify the location to perform a frozen biopsy during intraoperative frozen section consultation

Intraoperative Assessment of the Resection Specimen Facilitates Achievement of Adequate Margins in Oral Carcinoma

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