Intraoperative evaluation of bony margins with frozen‐section analysis and trephine drill extraction technique: A preliminary study

Wysluch, A.; Stricker, Ingo; Hölzle, Frank; Wolff, Klaus‐Dietrich; Maurer, P.

doi:10.1002/hed.21350

Cited by 33 publications

(20 citation statements)

References 31 publications

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“…Although little is known as to whether OSCC cells have the ability to resorb bone themselves, it is clear that osteoclasts are much involved in this process [14][15][16]. Osteoclasts differentiate at the bone surface and dissolve mineral components by an extracellular mechanism involving secretion of acid [17,18].…”

Section: Molecular Mechanismsmentioning

confidence: 99%

Potential molecular targets for inhibiting bone invasion by oral squamous cell carcinoma: a review of mechanisms

Quan

Johnson

Zhou

et al. 2011

Cancer Metastasis Rev

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Bone invasion is a common characteristic of oral squamous cell carcinoma (OSCC), with adverse affects on patient functionality and survival. Recent studies suggest that it is osteoclasts, rather than malignant keratinocytes themselves, which play the major role in facilitating the entry of the tumour into bone, and its progression within bone. Osteoclasts respond to a variety of local signalling pathways, initiated by products of the malignant epithelial cells. In the present review, we firstly introduce the clinical patterns of bone invasion, and then summarise these signalling pathways and their diverse roles in sequential phases of bone invasion. We also review current researches regarding the incidence and mechanisms of distant metastases to bone, and explain briefly the concept of epithelial-mesenchymal transition, which may generate cancer stem cells and initiate the bone invasion. Finally, we discuss more briefly approaches to the diagnosis and management of OSCC patients with bone invasion. With all these studies and some recent discoveries in our own laboratory, an enhanced understanding of bone invasion will be achieved, which should indicate potential molecular targets for future biotherapies.

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Section: Molecular Mechanismsmentioning

confidence: 99%

Potential molecular targets for inhibiting bone invasion by oral squamous cell carcinoma: a review of mechanisms

Quan

Johnson

Zhou

et al. 2011

Cancer Metastasis Rev

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“…Three other groups addressed this issue previously [6][7][8][9]. However, the current study characterizes IAN biopsies as a complementary method of mandibular bone margin assessment.…”

Section: Introductionmentioning

confidence: 96%

Oral Squamous Cell Carcinoma with Mandibular Bone Invasion: Intraoperative Evaluation of Bone Margins by Routine Frozen Section

Bilodeau

Chiosea

2011

Head and Neck Pathol

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The intraoperative knowledge of margin status on mandibulectomy specimens is important for primary reconstruction. The goal of this study was to evaluate whether intraoperative bone marrow (BM) curettings and inferior alveolar nerve (IAN) biopsies are representative of final decalcified cross-sectional (shave) mandibular bone margins. Forty-seven margins in 27 patients consecutively treated with segmental mandibulectomy for squamous cell carcinoma were reviewed. These patients had BM or IAN margins sampled by surgeons and assessed intraoperatively by routine frozen section. The full cross-section of mandibular bone margins were sampled by pathologists at the time of routine gross examination. Intraoperative evaluation of BM/IAN biopsies is characterized by a 50% sensitivity (3 of 6 cases were false negative) and a 100% specificity. IAN biopsies are representative of the final bone margin. Given the technical feasibility of intraoperative BM and IAN assessment, we favor routine intraoperative evaluation of mandibular bone margins. However, even when bone margins are sampled intraoperatively, obtaining a full cross-section of the bone margin at the time of gross examination should also be performed as it remains the most accurate modality of bone margin assessment.

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“…As a modification, cylindrical bone specimens were harvested from resection margins of the mandible by trephine drill extraction. Cryostat sections of 84 trephine specimens from 20 patients provided a sensitivity of 80% and a specificity of 95% . A more recent study assessed bone marrow curetting and inferior alveolar nerve biopsies of 47 margins from 27 patients by frozen section analysis compared with final decalcified cross‐sectional mandible bone margins.…”

Section: Discussionmentioning

confidence: 99%

“…The need for a definitive intraoperative evaluation of bone margins is obvious . Promising approaches have been presented to address this demand, including cytology . However, to our knowledge to date none of the approaches has obtained general acceptance, mostly due to the lack of practicability and reliability (Table 1) …”

Section: Introductionmentioning

confidence: 99%

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

Nieberler

Häusler

Drecoll

et al. 2014

Cancer Cytopathology

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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.

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Intraoperative evaluation of bony margins with frozen‐section analysis and trephine drill extraction technique: A preliminary study

Abstract: This technique promises to be suitable for intraoperative detection of malignant bone infiltration.

Cited by 33 publications

References 31 publications

Potential molecular targets for inhibiting bone invasion by oral squamous cell carcinoma: a review of mechanisms

Potential molecular targets for inhibiting bone invasion by oral squamous cell carcinoma: a review of mechanisms

Oral Squamous Cell Carcinoma with Mandibular Bone Invasion: Intraoperative Evaluation of Bone Margins by Routine Frozen Section

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

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