Positive fresh frozen section margins as an adverse independent prognostic factor for local recurrence in oral cancer patients

Szewczyk, Mateusz; Golusiński, Wojciech; Pazdrowski, Jakub; Masternak, Michał M.; Sharma, Neil; Golusiński, Paweł

doi:10.1002/lary.26890

Cited by 27 publications

(32 citation statements)

References 29 publications

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“…Three studies showed that patients with positive (<1 mm) margins cleared (≥1 mm) under FS guidance had poorer local control compared to those with initially clear (≥1 mm) margins. 11,13,14 Buchakjian et al 11 also showed that patients with positive margins cleared had comparable LR rates to those with persistently positive margins. Two studies showed that patients with positive (0 mm) margins cleared to negative (≥5 mm) had worse LRFS compared to those with initially negative (≥5 mm) margins.…”

Section: Resultsmentioning

confidence: 96%

Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta‐analysis

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Tarabichi

Sethi

et al. 2019

Otolaryngol.--head neck surg.

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Objectives To compare local recurrence-free survival (LRFS) in early oral cavity cancer (OCC) patients with positive/close frozen section (FS) cleared with further resection (R1 to R0) or positive FS not cleared (R1) to those with negative margins on initial FS analysis (R0). Data Sources PubMed, EMBASE, and Cochrane. Review Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for reporting in our study. Only English-language articles that included patients with OCC and local recurrence (LR) comparisons between R0 and initially R1 to final R0 or final R1 groups were included. We requested the raw data from the corresponding authors of eligible studies and performed an individual participant data (IPD) meta-analysis of LRFS outcomes across groups. Results Pooled LRFS data from 8 studies showed that patients in the R1 to R0 group had worse LRFS compared to the R0 group (hazard ratio [HR] = 2.897, P < .001). Patients in the R1 group were also found to have worse LRFS compared to the R0 group (HR = 3.795, P < .001). When compared to final R1 group, the initially R1 to final R0 only showed a trend toward better LRFS. Conclusion Margin revision of initially positive margins to “clear” based on FS guidance does not equate to an initially negative margin and does not significantly improve local control. These findings call into question the effectiveness of the current methodology of intraoperative FS in OCC resections and call for a prospective study to determine what system of resected specimen analysis best predicts completeness of resection.

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Section: Resultsmentioning

confidence: 96%

Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta‐analysis

Bulbul

Tarabichi

Sethi

et al. 2019

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

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“…Multiple investigations have tried to assess the impact of tumor cut‐through on long‐term control outcomes . Ettl et al found that, in a study of patients with head and neck SCC of various sites and subsites, initially positive FS margins translated to an overall recurrence rate of 42% compared to 16.2% in those with initially negative margins .…”

Section: Resultsmentioning

confidence: 99%

“…Patients with a positive FS margin also had lower disease‐free survival irrespective of stage of disease. Thus, the authors advocated that tumors requiring re‐resection to achieve negative margin status should be considered for adjuvant therapy . Conversely, in a retrospective cohort of 547 patients with OSCC, Patel et al suggested that in patients without regional disease, those requiring re‐resection to achieve negative margins behave similarly to those with initially negative margins.…”

Section: Resultsmentioning

confidence: 99%

Surgical margins in oral cavity squamous cell carcinoma: Current practices and future directions

et al. 2019

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Objective: To discuss the current available techniques for intraoperative margin assessment in the surgical treatment of oral squamous cell carcinoma (OSCC) through a review of the available literature.Methods: A systematic review was undertaken of the available English literature between 2008 through 2018 regarding surgical margins in OCSS. A total of 893 relevant articles were returned; 144 met criteria for review; and 64 articles were included.Results: In this review, we discuss the data surrounding the use of frozen section in OCSS. Additionally, alternative techniques for margin assessment are discussed, including Mohs, molecular analysis, nonfluorescent dyes, fluorescent dyes, autofluorescent imaging, narrow-band imaging, optical coherence tomography, confocal microscopy, high-resolution microendoscopy, and spectroscopy. For each technique, particular emphasis is placed on the local recurrence, disease-free survival, and overall survival rates when available.Conclusion: This review provides support for the practice of specimen-driven margin assessment when using frozen section analysis to improve the utility of the results. Finally, several alternatives for intraoperative margin assessment currently under investigation, including pathologic, wide-field imaging and narrow-field imaging techniques, are presented. We aim to fuel further investigation into methods for margin assessment that will improve survival for patients with OSCC through a critical analysis of the available techniques.

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“…8,[11][12][13] Despite the widespread use of FS, recent studies have shown that initially positive margins lead to worse outcomes than initially negative margins regardless of whether re-resection guided by FS was performed. 4,[14][15][16][17] Additionally, some studies have demonstrated that patients undergoing simple gross examination of the resection specimen have similar clear margin rates and outcomes compared to those having FS. 18,19 Ninety percent of surgeons reported that revision of a positive margin under FS guidance results in a negative margin, despite a lack of evidence for this claim.…”

Section: Introductionmentioning

confidence: 99%

Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members

et al. 2020

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Objectives/Hypothesis: To investigate the definition of a clear margin and the use of frozen section (FS) among practicing head and neck surgeons in oral cancer management. Study Design: Cross-sectional survey. Methods: We designed a survey that was sent to American Head and Neck Society (AHNS) members via an email link. Results: A total of 185 (13% of 1,392) AHNS members completed our survey. Most surgeons surveyed (96.8%) use FS to supplement oral cavity squamous cell carcinoma resections. Fifty-five percent prefer a specimen-based approach. The majority of respondents believe FS is efficacious in guiding re-resection of positive margins, with 81% considering the new margin to be negative. More than half of respondents defined a distance of >5 mm on microscopic examination as a negative margin. Conclusions: To avoid oral cancer resections that result in positive margins on final analysis, and thus the need for additional therapy, most surgeons surveyed use FS. A majority of surveyed surgeons now prefer a specimen-based approach to margin assessment. Although there is a debate on what constitutes a negative margin, most surgeons surveyed believe it to be >5 mm on microscopic examination.

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Positive fresh frozen section margins as an adverse independent prognostic factor for local recurrence in oral cancer patients

Abstract: 4. Laryngoscope, 128:1093-1098, 2018.

Cited by 27 publications

References 29 publications

Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta‐analysis

Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta‐analysis

Surgical margins in oral cavity squamous cell carcinoma: Current practices and future directions

Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members

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