Performance and survival outcomes of defect-driven versus specimen-driven method of frozen section intraoperative margin assessment in oral cancers

Maharaj, D; Thaduri, Abhinav; Jat, Bhanwar Lal; Poonia, Dharma Ram; Durgapal, Prashant; Rajkumar, K

doi:10.1016/j.ijom.2021.11.010

Cited by 3 publications

(7 citation statements)

References 19 publications

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“…Amit et al reported that among 71 patients with OCSCC, specimen-driven sampling had an improved rate of negative margins (84% vs 55%) and reduced need for adjuvant treatment (62% vs 90%) compared with defect-driven sampling. Similarly, Maharaj et al found that positive final margins were more frequent in defect- (11.8%) than specimen-driven (7.5%) margins. Horwich et al reported lower rates of positive final margins in specimen-driven (0.9%) than defect-driven (12.9%) margins.…”

Section: Discussionmentioning

confidence: 90%

“…First, intraoperative margin assessment can have limited clinical value given its low sensitivity for the margin final status. 10, 15 Amit et al 15 reported that specimen-driven margins had a 91% sensitivity for predicting final clear margins, whereas defect-driven margins had a sensitivity of only 22%. Because final margin status has been shown to be associated with recurrence, 7,21-23 intraoperative margin status may have an indirect relationship with recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Our negative findings corroborate those of 2 recent studies. Maharaj et al assessed 104 patients with T1 to T4 OCSCC and found no substantial difference in locoregional RFS (defect-driven, 62% vs specimen-driven sampling, 75%) or 18-month overall survival (defect, 76% vs specimen, 78%). Similar to our study findings, PNI (HR, 5.14; 95% CI, 1.60-16.52) was a prominent predictor of local RFS .…”

Section: Discussionmentioning

confidence: 99%

“…Our study findings corroborate those of prior studies, which showed lower rates of positive margins with the specimendriven technique. Amit et al 15 reported that among 71 patients with OCSCC, specimen-driven sampling had an improved rate of negative margins (84% vs 55%) and reduced need for adjuvant treatment (62% vs 90%) compared with defect-driven sampling. Similarly, Maharaj et al 16 found that positive final margins were more frequent in defect-(11.8%) than specimendriven (7.5%) margins.…”

Section: Discussionmentioning

confidence: 99%

“…There are discordant reports in the literature regarding the efficacy of specimen-driven sampling in reducing recurrence rates. Several studies have suggested that specimen-driven margin sampling is associated with lower recurrence rates, 8,[11][12][13][14][15] whereas others have not been able to demonstrate similar prognostic benefits. 16,17 This study aimed to assess the prognostic implications of defect-vs specimen-driven margin assessment methods on recurrence in OCSCC.…”

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confidence: 99%

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Margin Assessment Methods in Oral Cavity Squamous Cell Carcinoma and Recurrence

Wu,

Woody,

Hesse

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportancePositive margins and margin clearance are risk factors for recurrence in oral cavity squamous cell carcinoma (OCSCC), and these features are used to guide decisions regarding adjuvant radiation treatment. However, the prognostic value of intraoperative tumor bed vs resection specimen sampling is not well defined.ObjectiveTo determine the prognostic implications of intraoperative margin assessment methods (tumor bed vs resection specimen sampling) with recurrence among patients who undergo surgical resection for OCSCC.Design, Setting, and ParticipantsThis was a retrospective study of patients who had undergone surgical resection of OCSCC between January 1, 2000, and December 31, 2021, at a tertiary-level academic institution. Patients were grouped by margin assessment method (tumor bed [defect] or resection specimen sampling). Of 223 patients with OCSCC, 109 patients had localized tumors (pT1-T2, cN0), 154 had advanced tumors, and 40 were included in both cohorts. Disease recurrence after surgery was estimated by the cumulative incidence method and compared between cohorts using hazard ratios (HRs). Data analyses were performed from January 5, 2023, to April 30, 2023.Main Outcome and MeasuresRecurrence-free survival (RFS).ResultsThe study population comprised 223 patients (mean [SD] age, 62.7 [12.0] years; 88 (39.5%) female and 200 [90.0%] White individuals) of whom 158 (70.9%) had defect-driven and 65 (29.1%) had specimen-driven margin sampling. Among the 109 patients with localized cancer, intraoperative positive margins were found in 5 of 67 (7.5%) vs 8 of 42 (19.0%) for defect- vs specimen-driven sampling, respectively. Final positive margins were 3.0% for defect- (2 of 67) and 2.4% for specimen-driven (1 of 42) margin assessment. Among the 154 patients with advanced cancer, intraoperative positive margins were found in 29 of 114 (25.4%) vs 13 of 40 (32.5%) for defect- and specimen-driven margins, respectively. Final positive margins were higher in the defect-driven group (9 of 114 [7.9%] vs 1 of 40 [2.5%]). When stratified by margin assessment method, the 3-year rates of local recurrence (9.7% vs 5.1%; HR, 1.37; 95% CI, 0.51-3.66), regional recurrence (11.0% vs 10.4%; HR, 0.85; 95% CI, 0.37-1.94), and distant recurrence (6.4% vs 5.0%; HR, 1.10; 95% CI, 0.36-3.35) were not different for defect- vs specimen-driven sampling cohorts, respectively. The 3-year rate of any recurrence was 18.9% in the defect- and 15.2% in the specimen-driven cohort (HR, 0.93; 95% CI, 0.48-1.81). There were no differences in cumulative incidence of disease recurrence when comparing defect- vs specimen-driven cases.Conclusions and RelevanceThe findings of this retrospective cohort study indicate that margin assessment methods using either defect- or specimen-driven sampling did not demonstrate a clear association with the risk of recurrence after OCSCC resection. Specimen-driven sampling may be associated with reduced surgical margin positivity rates, which often necessitate concurrent chemotherapy with adjuvant radiation therapy.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Margin Assessment Methods in Oral Cavity Squamous Cell Carcinoma and Recurrence

Wu,

Woody,

Hesse

et al. 2023

JAMA Otolaryngol Head Neck Surg

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Resection status and margin control in intraoperative frozen sectioning analysis of oral squamous cell carcinoma

Neumann,

Straub,

Mrosk

et al. 2024

Oral Maxillofac Surg

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Purpose Intraoperative frozen section analysis (IFSA) is a well-established procedure for determining the intraoperative soft tissue resection status in patients with oral squamous cell carcinoma (OSCC). Margin status is a major predictor of the patient´s outcome, histologically free margins of ≥ 5 mm are demanded. This study evaluates the accuracy of IFSA, the impact of margin status and the impact of intraoperative margin revision on disease-free survival (DFS) and overall survival (OS). Methods This retrospective study included 213 patients with OSCC. IFSA results were compared with definitive histopathological reports, Kaplan–Meier analysis was performed. Cut-off values were calculated for resection margins considering known risk factors. Results IFSA showed positive margins in 8 cases (3.8%). Kaplan–Meier analysis revealed no significant differences for OS or DFS if R0-status was achieved by initial resection or immediate re-resection. Final histopathological evaluation revealed false-positive IFSA in 3/8 cases (37.5%) and false-negative IFSA in 1/205 cases (0.5%). Sensitivity was 83.3% and specificity was 98.6%. Analysis of optimal cut-off values showed no general need for larger resection margins in patients with risk factors. Cut-off values were slightly higher for patients with the risk factor alcohol consumption (7 mm for OS and DFS) or pN + ECS- disease (7 mm for DFS). Optimal cut-off values for tumour-margin-distance were around 6 mm. Conclusion IFSA provides a valuable assessment method for intraoperative soft tissue resection margins. Risk factors seemingly do not significantly influence the extent of tumour resection.

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Intraoperative Assessment of Resection Margin in Oral Cancer: The Potential Role of Spectroscopy

Vlocskó,

Piffkó,

Janovszky

2023

Cancers

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In parallel with the increasing number of oncological cases, the need for faster and more efficient diagnostic tools has also appeared. Different diagnostic approaches are available, such as radiological imaging or histological staining methods, but these do not provide adequate information regarding the resection margin, intraoperatively, or are time consuming. The purpose of this review is to summarize the current knowledge on spectrometric diagnostic modalities suitable for intraoperative use, with an emphasis on their relevance in the management of oral cancer. The literature agrees on the sensitivity, specificity, and accuracy of spectrometric diagnostic modalities, but further long-term prospective, multicentric clinical studies are needed, which may standardize the intraoperative assessment of the resection margin and the use of real-time spectroscopic approaches.

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Performance and survival outcomes of defect-driven versus specimen-driven method of frozen section intraoperative margin assessment in oral cancers

Cited by 3 publications

References 19 publications

Margin Assessment Methods in Oral Cavity Squamous Cell Carcinoma and Recurrence

Margin Assessment Methods in Oral Cavity Squamous Cell Carcinoma and Recurrence

Resection status and margin control in intraoperative frozen sectioning analysis of oral squamous cell carcinoma

Intraoperative Assessment of Resection Margin in Oral Cancer: The Potential Role of Spectroscopy

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