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Aires MM, Pereira I FY, Silva CD, Pedroso JEDS, Biase NGD, Haddad L. Predictive factors of frozen section in transoral microlaryngeal surgery for suspicious glottic lesions. Braz J Otorhinolaryngol 2024; 90:101434. [PMID: 38848629 PMCID: PMC11192773 DOI: 10.1016/j.bjorl.2024.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE Frozen biopsy may guide surgical intraoperative decisions. We evaluated the accuracy of frozen biopsy for diagnosing benign, dysplastic and malignant laryngeal lesions, compared to paraffin section (gold standard). METHODS Retrospective review of the charts of all patients presenting with laryngeal lesions suspicious of malignancy, who underwent laryngeal microsurgery with frozen biopsy in our institution, between 2015 and 2020. Results of frozen biopsy and paraffin section examinations were compared. RESULTS Among 113 samples of 89 patients, paraffin section diagnosed 23 benign, 31 dysplastic and 59 malignant lesions. The accuracy of the frozen biopsy in identifying dysplasia or malignancy was 80.5% (91/113), and greater for lesions >5 mm (78.8% × 51.5%; p = 0.009). The positive and negative predictive values, sensitivity and specificity were 95.9%, 51.3%, 78.9% and 86.9%, respectively. CONCLUSIONS Frozen section is a reliable tool when malignancy is detected, but almost half of benign results exhibit dysplasia or malignancy in paraffin section. Other clinical parameters should be considered in intraoperative decisions to prevent undertreatment. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mateus Morais Aires
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade de Pernambuco (UPE), Faculdade de Ciências Médicas, Recife, PE, Brazil
| | - Fábio Yukio Pereira I
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Camilla Diacópulos Silva
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - José Eduardo de Sá Pedroso
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Noemi Grigoletto de Biase
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Pontifícia Universidade Católica de São Paulo (PUC), São Paulo, SP, Brazil
| | - Leonardo Haddad
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
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Dehan LM, Lewis JS, Mehrad M, Ely KA. Patterns of Major Frozen Section Interpretation Error: An In-Depth Analysis From a Complex Academic Surgical Pathology Practice. Am J Clin Pathol 2023; 160:247-254. [PMID: 37141256 DOI: 10.1093/ajcp/aqad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES To establish baseline error rates due to misinterpretation and to identify scenarios in which major errors were most common and potentially preventable. METHODS Our database was queried over a 3-year period for major discrepancies due to misinterpretation. These were stratified by histomorphologic setting, service, availability/type of prior material, and years of experience and subspecialization of the interpreting pathologist. RESULTS The overall discordance rate between frozen section (FS) and final diagnoses was 2.9% (199/6,910). Seventy-two errors were due to interpretation, of which 34 (47.2%) were major. Major error rates were highest on the gastrointestinal and thoracic services. Of major discrepancies, 82.4% were rendered in subdisciplines outside those of the FS pathologist. Pathologists with fewer than 10 years' experience made more errors than those with more experience (55.9% vs 23.5%, P = .006). Major error rates were greater for cases without previous material compared to those with a prior glass slide (47.1% vs 17.6%, P = .009). Common histomorphologic scenarios in which disagreements were made involved discriminating mesothelial cells from carcinoma (20.6%) and accurately recognizing squamous carcinoma/severe dysplasia (17.6%). CONCLUSIONS To improve performance and decrease future misdiagnoses, monitoring discordances should be a continuous component of surgical pathology quality assurance programs.
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Affiliation(s)
- Lauren M Dehan
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - James S Lewis
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - Mitra Mehrad
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
| | - Kim A Ely
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, US
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Puram SV, Mays AC, Bayon R, Bell D, Chung J, Fundakowski CE, Johnson BT, Massa ST, Sharma A, Varvares MA. Margins in Stage I and II Oral Cavity Squamous Cell Carcinoma: A Review From the American Head and Neck Society. JAMA Otolaryngol Head Neck Surg 2023; 149:636-642. [PMID: 37289469 DOI: 10.1001/jamaoto.2023.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Importance The assessment and management of surgical margins in stage I and II oral cavity squamous cell carcinoma is one of the most important perioperative aspects of oncologic care, with profound implications for patient outcomes and adjuvant therapy. Understanding and critically reviewing the existing data surrounding margins in this context is necessary to rigorously care for this challenging group of patients and minimize patient morbidity and mortality. Observations This review discusses the data related to the definitions related to surgical margins, methods for assessment, specimen vs tumor bed margin evaluation, and re-resection of positive margins. The observations presented emphasize notable controversy within the field about margin assessment, with early data coalescing around several key aspects of management, although studies are limited by their design. Conclusions and Relevance Stage I and II oral cavity cancer requires surgical resection with negative margins to obtain optimal oncologic outcomes, but controversy persists over margin assessment. Future studies with improved, well-controlled study designs are required to more definitively guide margin assessment and management.
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Affiliation(s)
- Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
- Department of Genetics, Washington University in St Louis, St Louis, Missouri
| | - Ashley C Mays
- Department of Otolaryngology, Cleveland Clinic Florida, Cleveland Clinic Indian River Hospital, Vero Beach
| | - Rodrigo Bayon
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City
| | - Diana Bell
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jeffson Chung
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown
| | - Christopher E Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bradley T Johnson
- Ear, Nose, Throat and Plastic Surgery Associates, AdventHealth, Winter Park, Florida
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, St Louis University, St Louis, Missouri
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
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4
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Urken ML, Yun J, Saturno MP, Greenberg LA, Chai RL, Sharif K, Brandwein-Weber M. Frozen Section Analysis in Head and Neck Surgical Pathology: A Narrative Review of the Past, Present, and Future of Intraoperative Pathologic Consultation. Oral Oncol 2023; 143:106445. [PMID: 37285683 DOI: 10.1016/j.oraloncology.2023.106445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
Frozen section has remained the diagnostic gold standard for intraoperative pathological evaluation of surgical margins for head and neck specimens. While achieving tumor-free margins is of utmost importance to all head and neck surgeons, in practice, there are numerous debates and a lack of standardization for the role and method of intraoperative pathologic consultation. This review serves as a summary guide to the historical and contemporary practice of frozen section analysis and margin mapping in head and neck cancer. In addition, this review discusses current challenges in head and neck surgical pathology, and introduces 3D scanning as a groundbreaking technology to bypass many of the pitfalls in the current frozen section workflow. The ultimate goal for all head and neck pathologists and surgeons should be to modernize practices and take advantage of new technology, such as virtual 3D specimen mapping techniques, that improves the workflow for intraoperative frozen section analysis.
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Affiliation(s)
- Mark L Urken
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Jun Yun
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | | | - Lily A Greenberg
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA
| | - Raymond L Chai
- Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Kayvon Sharif
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Margaret Brandwein-Weber
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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5
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Neduvanchery S, Gochhait D, Srinivas BH, Harichandrakumar KT, Subramanian P, Shukkur N, Keerthana K, Penumadu P. Comparison of intraoperative imprints cytology with frozen section for lymph node metastasis in patients with head and neck squamous cell carcinoma. Diagn Cytopathol 2020; 49:252-257. [PMID: 32975911 DOI: 10.1002/dc.24622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/24/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intraoperative evaluation of lymph nodal metastasis in head and neck squamous cell carcinoma (HNSCC) assumes importance and avoids over-treatment in clinically node negative (N0) neck. Frozen section (FZ) is the commonly employed technique, but it requires significant investment in resources, time, and personnel. Intraoperative imprint cytology (IC) is a rapid, reliable, and inexpensive alternative. We conducted a prospective study to assess the diagnostic accuracy of intraoperative IC and FZ for lymph node metastasis in HNSCC. METHODS All patients presenting with HNSCC with clinically N0 neck undergoing surgery were included in the study, and intraoperative assessment of clinically suspicious nodes was done using IC and FZ and was reviewed by two independent pathologists. The sensitivity, specificity, and accuracy of IC and FZ were calculated with reference to the final histopathology report. The time duration for reporting was calculated. RESULTS Thirty-four patients with clinically N0 neck were included in the study, and 85 slides were examined. The sensitivity, specificity, and accuracy of FZ were 100%, 98.6%, and 98.9%, respectively, whereas for IC, it was 85.7%, 95.8%, and 94.1%, respectively. The mean time duration for reporting for FZ and IC was 41.18 ± 3.62 and 18.12 ± 2.01 minutes, respectively. CONCLUSION IC provides a cheaper, accurate, and rapid alternative for FZ for intraoperative assessment of neck nodes in HNSCC, and it assumes importance in resource-driven countries like India.
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Affiliation(s)
| | - Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Post Graduate Medical Education, Puducherry, India
| | | | | | | | | | - K Keerthana
- Department of Surgical Oncology, JIPMER, Puducherry, India
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Chakrabarti S, Singhavi HR, Bal M, Mair M, Malik A, Mahuvakar A, Singh A, Mathur R, Joshi P, Nair S, Nair D, Chaturvedi P. Intraoperative frozen section for detection of occult metastasis in clinically N0 neck does not improve outcome in oral cavity carcinomas. Eur Arch Otorhinolaryngol 2019; 276:2325-2330. [PMID: 31147769 DOI: 10.1007/s00405-019-05484-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/20/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the utility of frozen section (FS) in detecting occult nodal metastasis in cN0 OSCC and its impact on regional failure and survival. MATERIALS AND METHODS Clinical records of patients of OSCC operated from January 2013 to December 2014 were retrospectively reviewed. These patients were divided into two groups-Group A comprised of patients who underwent selective neck dissection (SND) (level III/IV) and FS based completion (level IV ± V); Group B included patients who underwent SND I-III/IV without FS. The sensitivity and specificity of FS in detecting occult metastasis was calculated. The regional failure rates and overall survival (OS) between the two groups were compared. RESULTS The sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) of FS in detecting occult metastasis were 64.06%, 100%, 100%, and 92.15%, respectively. There was no significant difference in regional failure rates (p = 0.219) and OS (p = 0.08) between the two groups. CONCLUSION FS has a poor sensitivity in detecting occult nodal metastasis. FS-guided neck dissection does not have a significant impact in reducing regional failure or improving OS in clinically node-negative neck in oral cavity carcinomas.
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Affiliation(s)
- Swagnik Chakrabarti
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | | | - Munita Bal
- Department of Head and Neck Pathology, Tata Memorial Centre, Mumbai, India
| | - Manish Mair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Akshat Malik
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Ankit Mahuvakar
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Arjun Singh
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Rachit Mathur
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Poonam Joshi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India.
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7
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Slooter MD, Handgraaf HJM, Boonstra MC, van der Velden LA, Bhairosingh SS, Que I, de Haan LM, Keereweer S, van Driel PBAA, Chan A, Kobayashi H, Vahrmeijer AL, Löwik CWGM. Detecting tumour-positive resection margins after oral cancer surgery by spraying a fluorescent tracer activated by gamma-glutamyltranspeptidase. Oral Oncol 2018; 78:1-7. [PMID: 29496035 DOI: 10.1016/j.oraloncology.2017.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/05/2017] [Accepted: 12/09/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Tumour-positive resection margins are a major problem during oral cancer surgery. gGlu-HMRG is a tracer that becomes fluorescent upon activation by gamma-glutamyltranspeptidase (GGT). This study aims to investigate the combination of gGlu-HMRG and a clinical fluorescence imaging system for the detection of tumour-positive resection margins. MATERIALS AND METHODS The preclinical Maestro and clinical Artemis imaging systems were compared in vitro and ex vivo with cultured human head and neck cancer cells (OSC19, GGT-positive; and FaDu, GGT negative) and tumour-bearing nude mice. Subsequently, frozen sections of normal and oral cancer tissues were ex vivo sprayed with gGlu-HMRG to determine the sensitivity and specificity. Finally, resection margins of patients with suspected oral cancer were ex vivo sprayed with gGlu-HMRG to detect tumour-positive resection margins. RESULTS Both systems could be used to detect gGlu-HMRG activation in vitro and ex vivo in GGT positive cancer cells. Sensitivity and specificity of gGlu-HMRG and the Artemis on frozen tissue samples was 80% and 87%, respectively. Seven patients undergoing surgery for suspected oral cancer were included. In three patients fluorescence was observed at the resection margin. Those margins were either tumour-positive or within 1 mm of tumour. The margins of the other patients were clear (≥8 mm). CONCLUSION This study demonstrates the feasibility to detect tumour-positive resection margins with gGlu-HMRG and a clinical fluorescence imaging system. Applying this technique would enable intraoperative screening of the entire resection margin and allow direct re-resection in case of tumour-positivity.
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Affiliation(s)
- Maxime D Slooter
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Martin C Boonstra
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lily-Ann van der Velden
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Ivo Que
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lorraine M de Haan
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Pieter B A A van Driel
- Optical Molecular Imaging, Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alan Chan
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Percuros B.V., Enschede, The Netherlands
| | - Hisataka Kobayashi
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, USA
| | | | - Clemens W G M Löwik
- Optical Molecular Imaging, Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Naveed H, Abid M, Hashmi AA, Edhi MM, Sheikh AK, Mudassir G, Khan A. Diagnostic accuracy of touch imprint cytology for head and neck malignancies: a useful intra-operative tool in resource limited countries. BMC Clin Pathol 2017; 17:25. [PMID: 29204102 PMCID: PMC5702091 DOI: 10.1186/s12907-017-0063-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023] Open
Abstract
Background Intraoperative consultation is an important tool for the evaluation of the upper aerodigestive tract (UAT) malignancies. Although frozen section analysis is a preferred method of intra-operative consultation, however in resource limited countries like Pakistan, this facility is not available in most institutes; therefore, we aimed to evaluate the diagnostic accuracy of touch imprint cytology for UAT malignancies using histopathology of the same tissue as gold standard. Methods The study involved 70 cases of UAT lesions operated during the study period. Intraoperatively, after obtaining the fresh biopsy specimen and prior to placing them in fixative, each specimen was imprinted on 4-6 glass slides, fixed immediately in 95% alcohol and stained with Hematoxylin and Eosin stain. After completion of the cytological procedure, the surgical biopsy specimen was processed. The slides of both touch Imprint cytology and histopathology were examined by two consultant histopathologists. Results The result of touch imprint cytology showed that touch imprint cytology was diagnostic in 68 cases (97.1%), 55 (78.6%) being malignant, 2 cases (2.9%) were suspicious for malignancy, 11 cases (15.7%) were negative for malignancy while 2 cases (2.9%) were false negative. Amongst the 70 cases, 55 cases (78.6%) were malignant showing squamous cell carcinoma in 49 cases (70%), adenoid cystic carcinoma in 2 cases (2.9%), non-Hodgkin lymphoma 2 cases (2.9%), Mucoepidermoid carcinoma 1 case (1.4%), spindle cell sarcoma in 1 case (1.4%). Two cases (2.9%) were suspicious of malignancy showing atypical squamoid cells on touch imprint cytology, while 13 cases (18.6%) were negative for malignancy, which also included 2 false negative cases. The overall diagnostic accuracy of touch imprint cytology came out to be 96.7% with a sensitivity and specificity of 96 and 100%, respectively while PPV and NPV of touch imprint cytology was found to be 100 and 84%, respectively. Conclusion Our experience in this study has demonstrated that touch imprint cytology provides reliable specific diagnoses and can be used as an adjunct to histopathology, particularly in developing countries, where the facility of frozen section is often not available, since a rapid preliminary diagnosis may help in the surgical management planning.
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Affiliation(s)
| | | | - Atif Ali Hashmi
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | | | | | - Amir Khan
- Kandahar University, Kandahar, Afghanistan
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Ashizawa K, Yoshimura K, Johno H, Inoue T, Katoh R, Funayama S, Sakamoto K, Takeda S, Masuyama K, Matsuoka T, Ishii H. Construction of mass spectra database and diagnosis algorithm for head and neck squamous cell carcinoma. Oral Oncol 2017; 75:111-119. [PMID: 29224807 DOI: 10.1016/j.oraloncology.2017.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/12/2017] [Accepted: 11/04/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Intraoperative identification of tumor margins is essential to achieving complete tumor resection. However, the process of intraoperative pathological diagnosis involves cumbersome procedures, such as preparation of cryosections and microscopic examination, thus requiring more than 30 min. Moreover, intraoperative diagnoses made by examining cryosections are occasionally inconsistent with postoperative diagnoses made by examining paraffin-embedded sections because the former are of poorer quality. We sought to establish a more rapid accurate method of intraoperative assessment. MATERIALS AND METHODS A diagnostic algorithm of head and neck squamous cell carcinoma (HNSCC) using machine learning was constructed by mass spectra obtained from 15 non-cancerous and 19 HNSCC specimens by probe electrospray ionization mass spectrometry (PESI-MS). The clinical validity of this system was evaluated using intraoperative specimens of HNSCC and normal mucosa. RESULTS A total of 114 and 141 mass spectra were acquired from non-cancerous and cancerous specimens, respectively, using both positive- and negative-ion modes of PESI-MS. These data were fed into partial least squares-logistic regression (PLS-LR) to discriminate tumor-specific spectral patterns. Leave-one-patient-out cross validation of this algorithm in positive- and negative-ion modes showed accuracies in HNSCC diagnosis of 90.48% and 95.35%, respectively. In intraoperative specimens of HNSCC, this algorithm precisely defined the borders of the cancerous regions; these corresponded with those determined by examining histologic sections. The procedure took approximately 5 min. CONCLUSION This diagnostic system, based on machine learning, enables accurate discrimination of cancerous regions and has the potential to provide rapid intraoperative assessment of HNSCC margins.
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Affiliation(s)
- Kei Ashizawa
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Kentaro Yoshimura
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Yamanashi, Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Hisashi Johno
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Yamanashi, Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Tomohiro Inoue
- Department of Human Pathology, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Ryohei Katoh
- Department of Human Pathology, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Satoshi Funayama
- Department of Radiology, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Kaname Sakamoto
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Sen Takeda
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Yamanashi, Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Keisuke Masuyama
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Tomokazu Matsuoka
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan.
| | - Hiroki Ishii
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan.
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Layfield EM, Schmidt RL, Esebua M, Layfield LJ. Frozen Section Evaluation of Margin Status in Primary Squamous Cell Carcinomas of the Head and Neck: A Correlation Study of Frozen Section and Final Diagnoses. Head Neck Pathol 2017; 12:175-180. [PMID: 28836224 PMCID: PMC5953870 DOI: 10.1007/s12105-017-0846-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/12/2017] [Indexed: 12/27/2022]
Abstract
Frozen section is routinely used for intraoperative margin evaluation in carcinomas of the head and neck. We studied a series of frozen sections performed for margin status of head and neck tumors to determine diagnostic accuracy. All frozen sections for margin control of squamous carcinomas of the head and neck were studied from a 66 month period. Frozen and permanent section diagnoses were classified as negative or malignant. Correlation of diagnoses was performed to determine accuracy. One thousand seven hundred and ninety-six pairs of frozen section and corresponding permanent section diagnoses were obtained. Discordances were found in 55 (3.1%) pairs. In 35 pairs (1.9%), frozen section was reported as benign, but permanent sections disclosed carcinoma. In 21 cases, the discrepancy was due to sampling and in the remaining cases it was an interpretive error. In 20 cases (1.1%), frozen section was malignant, but the permanent section was interpreted as negative. Frozen section is an accurate method for evaluation of operative margins for head and neck carcinomas with concordance between frozen and permanent results of 97%. Most errors are false negative results with the majority of these being due to sampling issues.
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Affiliation(s)
| | - Robert L. Schmidt
- Department of Pathology and Laboratory Medicine, University of Utah Health Care and ARUP Laboratories, Salt Lake City, UT USA
| | - Magda Esebua
- Department of Pathology and Anatomical Sciences, University of Missouri, One Hospital Drive, M263 Medical Sciences Building, Columbia, MO 65212 USA
| | - Lester J. Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, One Hospital Drive, M263 Medical Sciences Building, Columbia, MO 65212 USA
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12
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Du E, Ow TJ, Lo YT, Gersten A, Schiff BA, Tassler AB, Smith RV. Refining the utility and role of Frozen section in head and neck squamous cell carcinoma resection. Laryngoscope 2016; 126:1768-75. [DOI: 10.1002/lary.25899] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Eugenie Du
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Thomas J. Ow
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
- Department of Pathology; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Yung-Tai Lo
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Adam Gersten
- Department of Pathology; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Bradley A. Schiff
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Andrew B. Tassler
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Richard V. Smith
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
- Department of Pathology; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York U.S.A
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Montague L, Bhattacharyya I, Islam M, Cohen D, Fitzpatrick S. Direct immunofluorescence testing results in cases of premalignant and malignant oral lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:675-83. [DOI: 10.1016/j.oooo.2015.02.478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 01/03/2023]
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Agaimy A, Stelzle F, Zenk J, Iro H. [Intraoperative frozen section diagnosis of head and neck tumors: possibilities, limitations, pitfalls and tips for the daily practice]. DER PATHOLOGE 2012; 33:389-96. [PMID: 22907604 DOI: 10.1007/s00292-012-1598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Intraoperative consultation (synonym: frozen section diagnostics) has increasingly gained significance for the daily practice in head and neck surgery. The main aim of this investigation method which is usually associated with much stress and effort is to facilitate an optimal and timely oncological surgical treatment of neoplastic diseases with a minimum rate of postoperative functional disturbance. In order to achieve this purpose pathologists are expected to deliver as much correct information as possible to accurately influence intraoperative surgical decisions. At the same time this aim should be reached without significantly and unnecessarily increasing the workload for the pathology laboratory and without significantly inducing tissue artifacts. This would otherwise negatively influence the tissue quality for permanent section examination and consequently the overall quality of diagnosis and tumor staging. Thus, the quality and efficacy of frozen sections span a spectrum with the highest quality having the least possible false negative rate on the one hand and a false positive result of approximately zero on the other hand. Sticking to this approach would result in a high positive impact on the surgical treatment of a variety of neoplastic diseases and help to minimize or even eliminate the rate of medicolegal consequences.
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Affiliation(s)
- A Agaimy
- Pathologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 8-10, 91054, Erlangen, Deutschland.
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