The Utility of Frozen Sections in the Evaluation of Clear Margins in Oral Squamous Cell Carcinomas: A Cross-Sectional Study From a Tertiary Care Center

Abstract

Background and objectiveHead and neck cancers are prevalent in Pakistan. Oral squamous cell carcinomas are primarily treated via surgical removal, and complete surgical resection is the paramount prognostic factor. A resection margin of 5 mm on the final histopathology report has been accepted as adequate in the existing literature. Negative margins on the frozen section do not guarantee adequate disease-free resections on the final histopathology report. In this study, we aimed to ascertain how accurately tumor-free margins can be detected on frozen sections, which are reported intraoperatively compared to permanent sections of the same tissues reported after proper staining in oral squamous cell carcinoma patients. MethodsA cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan; 94 patients presenting between January and October 2016 were included in this study and a total of 432 tumor margins were assessed. ResultsAmong the total 94 patients included in the study, 79% were male and 21% were female. Buccal mucosa was the most commonly involved subsite (57%), followed by the tongue (25%). The most common T stage was T4 (33%), followed by T2 and T3 at 28% and 21% respectively, while the most common N stage was N0 (55%) followed by N1 at 16% and N2 at 22%. The sensitivity of the frozen section in comparison to the permanent section was found to be 50%, while specificity was calculated to be 99.8%. The positive predictive value was 75% and the negative predictive value was 99.3%. ConclusionThe frozen section is a highly useful tool for the evaluation of tumor margins. However, while it has high diagnostic accuracy rates, it can produce altered results and therefore requires high clinical correlation.

Intraoperative Assessment of Margin Accuracy in Early Oral Squamous Cell Carcinoma (cT1, T2, N0): Clinical Versus Frozen Section Analysis

“…In this study, the mean age was 53.03 years which is comparable with other studies by Wasif et al and Demir et al where the mean age of presentation was 52 and 57.4 years, respectively [ 13 , 14 ]. Regarding gender distribution, this study included more males (86%) than females (13%) which is comparable with other studies by Wasif et al [ 13 ].…”

“…All margins were analyzed by the oncology surgeon and subjected to frozen section analysis of the free margins (Figure 1, Table 3). [13,14]. Regarding gender distribution, this study included more males (86%) than females (13%) which is comparable with other studies by Wasif et al [13].…”

“…[13,14]. Regarding gender distribution, this study included more males (86%) than females (13%) which is comparable with other studies by Wasif et al [13]. The higher incidence in males was because of poor oral hygiene and constant use of betel which irritates the lower buccal mucosa and the alveolus causing cancer in the lower gingivobuccal sulcus.…”

“…A comparison of various studies of frozen section assessment was done. The accuracy of the frozen section in this study was 92.77% while the accuracy in other studies by Wasim et al, Demir et al, and Abbas et al was 99%, 96%, and 90.09%, respectively [13][14][15]. The frozen section accuracy of this study was in the same range as in previously reported studies.…”

“…The higher incidence in males was because of poor oral hygiene and constant use of betel which irritates the lower buccal mucosa and the alveolus causing cancer in the lower gingivobuccal sulcus. Oral carcinoma in western countries is due to unequal sharpness of teeth which can cause continuous irritation to the mucosa of the tongue [13][14][15].…”