To freeze or not to freeze? Should we be using intraoperative frozen sections?

Background and objectives: Intraoperative frozen section analysis of surgical margins is widely used in head and neck cancer surgery. Their use in management of oral squamous cell carcimoma (SCC) and other head and neck tumours is variable in the UK. The aim of this study was to evaluate frozen section accuracy and whether their use impacted on intraoperative management.

Methods: Consecutive frozen section results sent by our Oral and Maxillofacial Surgery Department, between April 2011 and March 2013, were analysed retrospectively and compared to the surgical margins reported from the final pathology specimen.

Results: Over the two-year period analysed, frozen sections were performed on 21 patients undergoing head and neck cancer surgery. The majority of cases were intraoral primary cancers (tongue or floor of mouth). The average number of frozen sections sent was five. In two cases frozen sections gave a false positive result and in four cases false negative. Sensitivity was 0 and specificity 0.88. In both cases of positive frozen sections, a wider margin was resected leading to clear final margins.

Conclusions: Frozen section margins are not sensitive, but are specific in this study, however only a small number of cases were analysed. Their potential benefit must be weighed against the cost of the procedure. Sampling error and interpretive error could account for the lack of sensitivity. We recommend careful sampling and sectioning of small biopsies and the need for vigilant communication between surgeon and pathologist.

Key words: frozen sections; cancer; margins

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on To freeze or not to freeze? Should we be using intraoperative frozen sections?
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