Frozen sections in head and neck surgery and the impact of intraoperative analysis on final resection margins : an institutional study

Abstract

BACKGROUND : Frozen section (FS) analysis is an indispensable tool for intraoperative patient management. AIMS : To assess the utilisation of head and neck FS analysis, with a particular focus on the concordance rate between the intraoperative FS margin analysis and the final FFPE results. Additionally, to determine whether FS analysis had any impact on intraoperative patient management. Lastly, to determine the impact of the FS analysis on the final margin status of resection specimens. MATERIALS AND METHODS : Histopathology reports from January 2015 to December 2018 were reviewed at Pretoria Oral and Dental Hospital to analyse all FS requests involving the head and neck region. Captured data was analysed to determine the concordance rate, discordance rate, and FS deferral rates, with correlations performed using the Chi-square test. RESULTS : Eighty-two frozen section cases were reviewed with a total of 312 FS tissue sections performed. The majority (73%) of the FS requests were from the Maxillofacial and Oral Surgery (MFOS) department for the assessment of surgical margins. The FS-FFPE concordance and discordance rates were at 97.5% and 2.4% respectively, with a deferral rate of 1.2%. Additional surgical margins were only received in 16 of the 26 cases with positive margins on intraoperative FS analysis. There was no statistically significant correlation between intraoperative FS positive margin status and advanced pathological T staging. CONCLUSIONS : The concordance rate between intraoperative FS margin analysis and final FFPE results were within an acceptable range. In a significant number of cases, the intraoperative FS margin analysis did not influence further surgical management.