Intraoperative frozen section histological analysis of resection samples is useful for the control of primary lesions in patients with oral squamous cell carcinoma

Abstract

Abstract. To ensure reliable surgical margins, intraoperative frozen section histological analysis (FS) has been performed since October, 2005 as follows: i) the orientation at the anatomical position and extent of the tumor are shared between oral pathologists and oral surgeons using imaging evaluations and pathological pictures and the planned site of sampling for intraoperative FS is confirmed; ii) a tumor team is organized and the team marks the tumor area and sets the resection range to correct the setting errors of the resection range among operators; iii) vital Lugol staining is applied to the lesion prior to tumor resection, the surgical margin is set based on the non-stained region and the extent of the tumor is macroscopically confirmed in the maximum cross-sectional surface of the resected specimen; and iv) FS is performed using samples from resected specimens to confirm the mucoepithelium and safety margin of the deep stump. The aim of this study was to evaluate the usefulness of our FS method. The treatment outcomes of oral squamous cell carcinoma were retrospectively investigated in patients treated prior to (Group 1) and after (Group 2) the introduction of our FS method. The recurrence rate of the primary lesions was high (17.3%) in Group 1, but decreased significantly in Group 2 (6.9%). Regarding clinicopathological factors, the condition of the surgical margins was associated with recurrence of the primary lesion in Group 1, but not in Group 2. In conclusion, our FS method appears to be useful for resecting tumors with reliable safety margins.

Narrow band imaging in the intra-operative definition of resection margins in oral cavity and oropharyngeal cancer

“…Other problems that have been encountered concern the site where the FS should be collected (surgical bed vs specimen) [30] and the risk of not precisely identifying the area to be enlarged in the event of positive margins [35]. Possible solutions have, however, been proposed [36].…”

Toward assessment of resection margins using hyperspectral diffuse reflection imaging (400–1,700 nm) during tongue cancer surgery

“…Currently, only frozen section technology is often used for this purpose. However, this approach is time-consuming and has the limitations that it is only possible to evaluate the resection plane superficially, and thus, cannot detect close margins [22]. Steens et al [23] evaluated the use of ex vivo magnetic resonance (MR) to evaluate the resection margins of the tongue specimens.…”

Diagnostic Accuracy of Confocal Laser Endomicroscopy for the Diagnosis of Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

“…The current practices which help in determining surgical margins include visualisation, palpation, or frozen section histopathology [ 16 ]. Although frozen sections are accurate, they are associated with multiple drawbacks, including compromising the tissue integrity and being time consuming [ 17 ]. Avoiding unnecessary resection of healthy tissues is of utmost importance to the surgeons, due to the functional limitations post-operatively and severe impact on the quality of life of the patient [ 18 , 19 ].…”