Evaluation of intraoperative cytological assessment of bone resection margins in patients with oral squamous cell carcinoma

Abstract

BACKGROUND:Frozen sections are routinely applied to control for adequate resection margins. In cases in which carcinoma infiltrates bone, the intraoperative microscopic assessment of bone margins remains challenging due to technical difficulties to section native bone. The objective of the current study was to evaluate an intraoperative cytological approach to control bone resection margins in patients with bone-infiltrating oral squamous cell carcinomas. METHODS:A total of 174 cytological preparations obtained from bone margins of bone-infiltrating oral squamous cell carcinomas (28 patients) were assessed intraoperatively and compared with the corresponding histological findings. In a validation cohort (45 patients) the intraoperative cytological assessment of bone resection margins (ICAB) (104 margins) was evaluated as a diagnostic tool for routine clinical application. RESULTS: In the first patient cohort, the ICAB revealed 95.3% sensitivity and 96% specificity. The results provided an accuracy of 95.7% with a significant correlation noted between cytological and histological results (j, 0.91; P <.001), and a positive predictive value and negative predictive value of 93.8% and 96.9%, respectively. In the validation cohort, ICAB revealed 80% sensitivity and 98.9% specificity with 98% accuracy. There was a significant correlation found between cytological and histological results (j, 0.91; P <.001), providing a positive predictive value and negative predictive value of 80% and 98%, respectively. ICAB could predict final resection status at bone margins with 80% sensitivity and 97.5% specificity. A significant correlation was found between the cytological and histological resection status at bone margins (j, 0,75; P <.001). CONCLUSIONS: ICAB could supplement intraoperative frozen sections of soft tissue margins as a standard procedure to control for adequate resection at bone margins. Cancer (Cancer Cytopathol) 2014;122:646-56.

Diagnostic accuracy of touch imprint cytology for head and neck malignancies: a useful intra-operative tool in resource limited countries

“…Their study concluded the sensitivity and specificity of touch imprint cytology as 95.3% and 96% respectively. The positive predictive value, negative predictive value and diagnostic accuracy of their study came out to be 93.8, 96.9 and 95.7% respectively [ 27 ].…”

Intraoperative Radiographic Assessment of Bone Resection Margins During Mandibulectomy: A Case Series

“…In 2014, Nieberler et al described a method for cytological assessment, in which specimen margins were scraped, placed onto slides, stained, and assessed by cytopathologists. 6 Through this method, they obtained a sensitivity of 94.4% and sensitivity of 97.5% through a reasonably short specimen preparation and assessment process. This was the first approach for assessing cortical bone specimens, though described limitations included specimen desiccation, insufficient material, and low quality cytologic preparations due to the presence of blood cells.…”

“…3,5 Unlike soft tissue, bone resection margins are not obtainable through frozen sections, due to high mineral content. 6 Therefore, histopathological confirmation of the presence of tumor cells is only available days after surgery. 5,6 Despite the importance of margins, and the long latency of traditional histopathological methods, there remain few alternatives for intraoperative assessment of resection margins during mandibulectomy other than conventional visual inspection and palpation, which may be inadequate in many cases.…”

“…6 Therefore, histopathological confirmation of the presence of tumor cells is only available days after surgery. 5,6 Despite the importance of margins, and the long latency of traditional histopathological methods, there remain few alternatives for intraoperative assessment of resection margins during mandibulectomy other than conventional visual inspection and palpation, which may be inadequate in many cases. Intraoperative cytological assessment has been described as a promising technique, though may be limited by specimen desiccation or insufficient material.…”

Development of a Rapid Analysis Method for Bone Resection Margins for Oral Squamous Cell Carcinoma by Immunoblotting

“…No full cross-section analysis, risk of missing infiltrated areas, presence of scattered tumour cells due to operation Nieberler et al [27] Cytological analysis cells obtained by a cytobrush Accelerated fixation and decalcification…”