Accuracy of intraoperative frozen section diagnosis in head and neck surgery: Experience at a university medical center

Abstract

We performed 2,210 intraoperative frozen sections on 258 patients from the Otolaryngology-Head and Neck Surgery Service in 1990 and 1991. Surgery involved a wide variety of benign and malignant lesions. Techniques included biopsies for diagnosis, simple excision, thyroid and salivary gland surgeries, lymph node biopsies, composite resections with radical neck dissections, laryngectomies, and skull base surgeries. During the 2-year period, 1,947 (88.1%) sections were requested for evaluation of surgical margins, 258 (11.7%) for diagnosis, and five (0.2%) cases for tissue identification. There was disagreement between the frozen section and permanent section in 46 (2.1%) cases, and the deferral diagnosis rate was 0.8%. Disagreements were the result of sampling errors in 33 and interpretive errors in 13 cases. There were six (0.3%) false-negative diagnosis of malignancy and four (0.2%) false-positive diagnoses of malignancy. Three of these had an impact on patient care as discussed. We recommend careful sampling and sectioning of small biopsies and the need for vigilant communication between surgeon and pathologist.

Study of Frozen Section Biopsy as Intraoperative Procedure for Oral Squamous Cell Carcinoma in BSMMU

“…9 In this study, these type of errors were observed in 4 margins in 3 patients. Out of which, 0.9 % was false positive and the rest 2.7% were false negative.…”

Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level

“…10,11 Error rates for frozen section margins are generally low, with reported frozen-permanent correlation rates as low as 96% and as high as 99%. [10][11][12][13][14][15][16][17][18][19] Correlation rates have been similarly high in studies that focused exclusively on head and neck cases, ranging from 96 to 98%. [10][11][12][13]15 However, there are few studies involving large academic centers.…”

Early outcomes after transoral CO2 laser resection of laryngeal and hypopharyngeal squamous cell carcinoma: one centre's experience

“…15,16 False positive reports have also been noted, resulting in wider resection margins which complicate surgical closure and subsequent functional outcomes. 17 As frozen-section examination was not encouraged by our histopathology department, a low threshold for second look procedures was adopted in our department as an acceptable practice. All patients in the current series were made aware of this possibility during the consent process.…”