Comparison of intraoperative imprints cytology with frozen section for lymph node metastasis in patients with head and neck squamous cell carcinoma

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.

Comparison of intraoperative imprint cytology with frozen section for lymph node metastasis in patients with head and neck cancer

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Background: Intraoperative evaluation of lymph nodal metastasis in head and neck carcinoma assumes importance in deciding the extent of lymph node dissection. Frozen section is the most commonly employed technique. But it requires significant investment in terms of resources, time and personnel. Intraoperative imprint cytology is a rapid, reliable and an inexpensive alternative. So we conducted a prospective diagnostic test accuracy study to assess the diagnostic accuracy of intraoperative imprint cytology and frozen section for lymph node metastasis in Head and neck Cancer when compared to Gold standard, which is the final Histopathology. Methods: All patients presenting with squamous cell carcinoma of head and neck with clinically N0 neck undergoing surgery as primary treatment were included in the study. For patients undergoing surgery, neck nodal tissue were sent for intraoperative assessment of clinically suspicious nodes. Intraoperative assessment was done by imprint cytology and frozen section and was reviewed and reported by two independent pathologist. The sensitivity, specificity and accuracy of imprint cytology and frozen section were calculated with reference to the final histopathology report. Time duration for reporting were also calcuted for both. Results: Total 34 patients with clinically N0 neck were included in the study and 85 slides were examined for frozen section and imprint cytology. Occult nodal metastasis was found in 16 patients (47.06%). The mean time duration for reporting for frozen was 41.18 ±3.62 minutes where as for imprint cytology it was 18.12 ±2.01 minutes. The concordance rate between the frozen section and imprint cytology was 94.12%. The sensitivity of frozen section was 100 % where as for imprint cytology it was 85.7 %( p = 0.00). The specificity was 98.6 % for frozen section and 95.8 % for imprint cytology (p = 0. 27). The positive predictive value was 93.3 % and 80 % for frozen section and imprint cytology respectively (p = 0.01). The negative predictive value was 100% for frozen section and 97.1% for imprint cytology (p = 0.12). The accuracy for frozen section was 98.8 % where as for imprint cytology it was 94.1%(p = 0.09). Conclusions: Imprint cytology provides a cheaper, accurate, reliable and a rapid alternative for frozen section for intraoperative assessment of neck nodes in squamous cell carcinoma of head and neck and it assumes importance in resource driven countries like India.

Carcinoma in a Colonic Conduit Post Esophagectomy: a Case Report

Colon Conduit is a commonly used form of reconstruction post esophagectomy either for malignancy, strictures due to caustic acid ingestion, or other benign conditions. Carcinoma of the Colon Conduit following esophagectomy is a complication with an extremely low incidence and the management options are not clear. Thorough search of literature showed only 16 such cases. Hence, we report a case of a patient who underwent colon conduit reconstruction for a gastroesophageal (GE) junction tumor and developed a recurrence 4 years after the initial surgery.