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Clinical Impact of Intraoperative Cytological Assessment of Bone Resection Margins in Patients with Head and Neck Carcinoma

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Surgical treatment of head and neck squamous cell carcinoma (HNSCC) patients often results in complex defects, affecting functional structures. Frozen sections are valuable to guide resections and control for adequate margins; however, intraoperative assessment of bone remains challenging.

Objective

The objective of this study was to evaluate the clinical impact of an intraoperative cytological assessment of bone margins (ICAB) on resection status and patient outcome.

Methods

ICAB analysis (n = 267) was implemented in 102 patients during resection of HNSCC for a guided resection of affected bone. The cytological findings were compared with the final histological results of the corresponding bone margins, and the surgical consequences, R1 rates, and patient outcome of the ICAB intervention group were compared with an equal control group of 100 patients.

Results

ICAB revealed a sensitivity of 94.4 % [95 % confidence interval (CI) 81.3–99.3], specificity of 97.4 % (95 % CI 94.4–99.0), positive predictive value of 85.0 % (95 % CI 70.2–94.3), and negative predictive value of 99.1 % (95 % CI 96.9–99.9). Osseous R1 resections were reduced from 8 to 2.9 % (∆R1 = 5.1 %; p = 0.113), rendering a relative risk reduction (RRR) of 63.2 % with a number needed to treat (NNT) of 19.57. ICAB influenced final resection status, with a reduction of R1 resections from 17 to 7.8 % (∆R1 = 9.2 %; p = 0.026), with an RRR of 59.65 % and an NNT of 9.66. The ICAB intervention group revealed a higher disease-free survival [p(log-rank) = 0.045] and overall survival [p(log-rank) = 0.014] according to multivariable analysis.

Conclusion

ICAB, applied as a routine diagnostic tool to supplement frozen sections, can help to reduce R1 resections in order to improve patient outcome.

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Acknowledgment

We highly appreciate the support of the Institute of Medical Statistics and Epidemiology (IMSE), Technische Universität München.

Disclosure

None declared.

Funding

No specific funding was provided for this work and there are no financial disclosures from any of the authors.

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Author notes

    Authors and Affiliations

    1. Department of Oral and Maxillofacial Surgery, Hospital rechts der Isar, Technische Universität München, Munich, Germany

      Markus Nieberler MD, DDS, Patrick Häußler MD, Marco Rainer Kesting MD, DDS, Andreas Kolk MD, DDS, Herbert Deppe DDS & Klaus-Dietrich Wolff MD, DDS

    2. Institute of Pathology, Technische Universität München, Munich, Germany

      Gregor Weirich MD, PhD

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    1. Markus Nieberler MD, DDS
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    2. Patrick Häußler MD
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    6. Gregor Weirich MD, PhD
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    7. Klaus-Dietrich Wolff MD, DDS
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    Correspondence to Markus Nieberler MD, DDS.

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    Gregor Weirich and Klaus-Dietrich Wolff have contributed equally to this work.

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    Nieberler, M., Häußler, P., Kesting, M.R. et al. Clinical Impact of Intraoperative Cytological Assessment of Bone Resection Margins in Patients with Head and Neck Carcinoma. Ann Surg Oncol 23, 3579–3586 (2016). https://doi.org/10.1245/s10434-016-5208-1

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    • DOI: https://doi.org/10.1245/s10434-016-5208-1

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