Refining the utility and role of Frozen section in head and neck squamous cell carcinoma resection

Du, Eugenie; Ow, Thomas J.; Lo, Yungtai; Gersten, Adam; Schiff, Bradley A.; Tassler, Andrew B.; Smith, Richard V.

doi:10.1002/lary.25899

Cited by 66 publications

(93 citation statements)

References 17 publications

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“…This would eliminate 6 tumor samples, 3 of which showed discordance with CRS imaging. After development of a tissue handling protocol which involved properly sectioning the specimens, the authors saw an increase in the efficiency and quality of the images produced, along with an increase in the overall sensitivity to 94.4% which is higher than previously demonstrated sensitivity of frozen margins 6 .…”

Section: Resultsmentioning

confidence: 95%

“…Limitations include sampling errors between the margin, specimen and resection bed, with discordance between whether or not to resect more “normal tissue” posing a difficult problem to the surgeon. 4,5 Additionally, studies on the frozen section analysis in head and neck carcinoma reveal the sensitivity to be between 83.1-88.8%, allowing for a false negative rate which can result in unrecognized residual disease 4-6 . Finally, frozen section analysis is time and resource consuming.…”

Section: Introductionmentioning

confidence: 99%

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Coherent Raman Scattering Microscopy for Evaluation of Head and Neck Carcinoma

Hoesli

Orringer

McHugh

et al. 2017

Otolaryngol.--head neck surg.

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Objective We aim to describe a novel, label-free, real-time imaging technique, coherent Raman scattering (CRS) microscopy, for histopathological evaluation of head and neck cancer. We evaluated the ability of CRS microscopy to delineate between tumor and non-neoplastic tissue in tissue samples from head and neck cancer patients. Study Design Prospective Case Series Setting Tertiary Care Medical Center Subjects and Methods Patients eligible were surgical candidates with biopsy proven, previously untreated head and neck carcinoma and were consented pre-operatively for participation in this study. Tissue was collected from 50 patients, and after confirmation of tumor and normal specimens by H&E, there were 42 tumor samples and 42 normal adjacent controls. Results There were 42 confirmed carcinoma specimens on H&E, CRS microscopy identified 38 as carcinoma. Of the 42 normal specimens, CRS microscopy identified 40 as normal. This resulted in a sensitivity of 90.5% and specificity of 95.2% in distinguishing between neoplastic and non-neoplastic images. Conclusion CRS microscopy is a unique label free imaging technique that can provide rapid, high-resolution images, and can accurately determine the presence of head and neck carcinoma. This holds potential for implementation into standard practice, allowing frozen margin evaluation even at institutions without a histopathology laboratory.

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Section: Resultsmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Coherent Raman Scattering Microscopy for Evaluation of Head and Neck Carcinoma

Hoesli

Orringer

McHugh

et al. 2017

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

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“…In this feasibility study, the quantification results were validated by the pathologic diagnosis in formalin-fixed paraffin-embedded tissue, which was reported to be more accurate than the frozen pathology (7, 8). In the future, we would like to further assess the value of HIS by comparing its performance with surgeons’ assessment in the OR, and also with frozen sections diagnosis in the pathology room.…”

Section: Discussionmentioning

confidence: 95%

“…Intraoperative frozen section assessment of surgical margins is widely used to assist in complete tumor extirpation in head and neck surgery. However, frozen section histopathology requires multiple, well-trained professionals, increases the cost and the duration of procedures, extends anesthesia-related risks, and provides diagnostic information at only a few discrete locations of the resection margins (7). Freezing artifacts, such as distortion of tissue architecture, uneven sectioning or poor staining, increases the likelihood of interpretive errors of histologic diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…Freezing artifacts, such as distortion of tissue architecture, uneven sectioning or poor staining, increases the likelihood of interpretive errors of histologic diagnosis. The overall frozen section accuracy has been reported to be only 71.3% and 77.9% in the evaluation of close (<5 mm) or positive final margins in two comprehensive studies (7, 8). Therefore, intraoperative imaging techniques that can help the surgeon to visualize and guide the tumor excision could improve complete surgical resection while preserving vital anatomic structures and functions of patients with head and neck cancer.…”

Section: Introductionmentioning

confidence: 99%

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Detection of Head and Neck Cancer in Surgical Specimens Using Quantitative Hyperspectral Imaging

Little

Wang

et al. 2017

Clinical Cancer Research

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Purpose This study intends to investigate the feasibility of using hyperspectral imaging (HSI) to detect and delineate cancers in fresh, surgical specimens of patients with head and neck cancers. Experimental Design A clinical study was conducted in order to collect and image fresh, surgical specimens from patients (N = 36) with head and neck cancers undergoing surgical resection. A set of machine-learning tools were developed to quantify hyperspectral images of the resected tissue in order to detect and delineate cancerous regions which were validated by histopathologic diagnosis. More than two million reflectance spectral signatures were obtained by HSI and analyzed using machine-learning methods. The detection results of HSI were compared with autofluorescence imaging and fluorescence imaging of two vital-dyes of the same specimens. Results Quantitative HSI differentiated cancerous tissue from normal tissue in ex vivo surgical specimens with a sensitivity and specificity of 91% and 91%, respectively, and which was more accurate than autofluorescence imaging (P < 0.05) or fluorescence imaging of 2-NBDG (P < 0.05) and proflavine (P < 0.05). The proposed quantification tools also generated cancer probability maps with the tumor border demarcated and which could provide real-time guidance for surgeons regarding optimal tumor resection. Conclusions This study highlights the feasibility of using quantitative HSI as a diagnostic tool to delineate the cancer boundaries in surgical specimens, and which could be translated into the clinic application with the hope of improving clinical outcomes in the future.

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Use of Intraoperative Frozen Section to Assess Final Tumor Margin Status in Patients Undergoing Surgery for Oral Cavity Squamous Cell Carcinoma

Long

Mclean

Valero

et al. 2022

JAMA Otolaryngol Head Neck Surg

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ImportanceMethods of assessing final margin status in patients undergoing surgery for oral cavity squamous cell carcinoma, such as intraoperative frozen section histopathology (IFSH) taken from the tumor bed, may have limitations in accuracy.ObjectiveTo evaluate the accuracy and implications of using IFSH samples to assess tumor bed margins in patients undergoing surgery for oral cavity squamous cell carcinoma (SCC).Design, Setting, and ParticipantsThis cross-sectional study included 1257 patients who underwent surgery for oral cavity SCC between January 1, 2000, and December 31, 2015, at an academic cancer center. A total of 4821 IFSH samples were examined from 1104 patients (87.8%) who had at least 1 IFSH sample. Institutional practice is to harvest margins for IFSH from the tumor bed. Statistical analysis was performed from August 1, 2021, to April 4, 2022.Main Outcomes and MeasuresSensitivity and specificity were calculated for IFSH samples of margins compared with the permanent pathology samples of the same tissue and for IFSH compared with the final tumor specimen histopathology (FTSH). Results were classified using a binary method, with histopathologic reports interpreted as either negative (including negative or atypia or dysplasia) or positive (including carcinoma in situ, suspicious, or positive).ResultsA total of 1257 patients met the inclusion criteria, including 709 men (56.4%), with a median age of 62 years (IQR, 52-73 years); 1104 patients (627 men [56.8%]; median age, 62 years [IQR, 52-72 years]) had IFHS samples. For IFSH relative to permanent sections of the IFSH tissue, sensitivity and specificity of IFSH were high (sensitivity, 76.5% [95% CI, 67.5%-85.5%]; specificity, 99.9% [95% CI, 99.8%-100%]), with discordant results in 24 of 4821 total specimens (0.5%). Final specimen margins were positive in 11.7% of patients (147 of 1257). Compared with FTSH, the sensitivity of IFSH for defining margin status was 10.8% (95% CI, 5.8%-15.8%), and the specificity was 99.1% (95% CI, 98.8%-99.4%). The rate of discordance was 4.0% (171 of 4284 specimens) between IFSH and FTSH.Conclusions and RelevanceThe findings of this cross-sectional study suggest that IFSH is accurate compared with permanent pathologic characteristics of the same tissue, but less reliable at assessing final margin status on the tumor specimen. Despite a high specificity, the sensitivity of IFSH compared with FTSH is low, which may be associated with the inherent inability of tumor bed IFSH margin analysis to accurately account for the 3-dimensional association of tumor margins with the periphery of the specimen and the overall low rate of positive final tumor margins. Although tumor bed IFSH is widely used in the management of oral cavity cancer, this study suggests that there are limitations of this modality in assessing the final surgical margin status.

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Refining the utility and role of Frozen section in head and neck squamous cell carcinoma resection

Abstract: N/A. Laryngoscope, 126:1768-1775, 2016.

Cited by 66 publications

References 17 publications

Coherent Raman Scattering Microscopy for Evaluation of Head and Neck Carcinoma

Coherent Raman Scattering Microscopy for Evaluation of Head and Neck Carcinoma

Detection of Head and Neck Cancer in Surgical Specimens Using Quantitative Hyperspectral Imaging

Use of Intraoperative Frozen Section to Assess Final Tumor Margin Status in Patients Undergoing Surgery for Oral Cavity Squamous Cell Carcinoma

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