Abstract
Complex anatomy of oral cavity makes it difficult for a surgeon to assess margins of oral cancer accurately and positive margins compromise loco regional disease control, thus surgeon may rely on frozen section assessment for marginal status. We discussed the prognostic value of frozen section in early carcinoma of oral cavity. 90 patients with pT1 and pT2 oral cavity cancer operated from January 2010 to December 2011 under single consultant surgeon were retrospectively evaluated. Log rank test and multivariate cox regression model was used for testing frozen section against the survival and recurrence free status. Survival of patients with positive or negative frozen section was significant (p = 0.037), Survival of patients with positive or negative histology report was significant (p = 0.004), however; prognosis of patients with positive margins despite revision under frozen control was poorer to the patients with negative margin. Frozen section assessment is accurate but their use in the surgery of oral cavity cancer might not improve loco regional disease control or survival when used routinely.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kaufman Z, Lew S, Griffel B et al (1986) Frozen-section diagnosisin surgical pathology: a prospective analysis of 526 frozen sections. Cancer 57:377
Rogers C, Klatt EC, Chandrasoma P (1987) Accuracy of frozen section diagnosis in a teaching hospital. Arch Pathol Lab Med 111:514
Howanitz PJ, Hoffman GG, Zarbo RJ (1990) The accuracy of frozen section diagnoses in 34 hospitals. Arch Pathol Lab Med 114:355
Ord Robert A, Aisner S (1997) Accuracy of frozen sections in assessing margins in oral cancer resection. J Oral Maxillofac Surg 55:663–669
Batsakis JG (1999) Surgical excision margins: a pathologist’s perspective. Adv Anat Pathol 6:140–148
Brandwein-Gensler M, Teixeira MS et al (2005) Squamous cell carcinoma histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival. Am J Surg Pathol 29(2):167–178
Woolgar JA, Triantafyllou A (2005) A histopathological appraisal of surgical margins in oral and oropharyngeal cancer resection specimens. Oral Oncol 41:1034–1043
Helliwell T, Woolgar JA (2005) Standards and minimum datasets for reporting cancers. Dataset for histopathologic reports on head and neck carcinomas and salivaryneoplasms, 2nd edn. Royal College of Pathologists, London
Loree TR, Strong EW (1990) Significance of positive margins in oral cavity squamous carcinoma. Am J Surg 160:410–414
Binahmed A, Nason RW, Abdoh AA (2007) The clinical significance of positive surgical margin in oral cancer. Oral Oncol 43:780–784
Byers RM, Bland KI, Borlase B, Luna M (1978) The prognostic and therapeutic value of frozen section determination in the surgical treatment of squamous carcinoma of the head and neck. Am J Surg 136:525–528
Pathak KA, Nason RW, Penner C, Viallet NR, Sutherland D, Kerr PD (2009) Impact of frozen section assessment of operative margins on survival in oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:235–239
Kerawala CJ, Ong TK (2001) Relocating the site of frozen sections-Is there room for improvement? Head Neck 23:230–232
Lee JG (1974) Detection of residual carcinoma of the oral cavity, oropharynx, hypopharynx and larynx: a study of surgical margins. Trans Am Acad Ophthalmol Otolaryngol 78:49–53
Chen TY, Emrich LJ, Driscoll DL (1987) The clinical significance of pathological findings in surgically resected margins of the primary tumor in head and neck Carcinoma. Int J Radiat Oncol Biol Phys 13:833–837
Kovacs AF (2004) Relevance of positive margins in case of adjuvant therapy of oral cancer. Int J Oral Maxillofac Surg 33:447–453
Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, Ozsahin EM, Jacobs JR, Jassem J, Ang KK (2005) Lefèbvre Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27(10):843–850
Chievitz JH (1885) Beitrage zur Entwicklungsgeschichte der Speicheldrusen. Arch Anat Physiol 9:401–436
Eversole LR, Leider AS (1978) Maxillary intraosseous neuroepithelial structures resembling those seen in the organ of Chievitz. Oral Surg Oral Med Oral Pathol 46:555–558
Danforth RA, Baughman RA (1979) Chievitz’s organ: a potential pitfall in oral cancer diagnosis. Oral Surg Oral Med Oral Pathol 48:231–236
Miko T, Molnar P (1981) The juxtaoral organ: a pitfall for pathologists. J Pathol 133:17–23
Spiro RH, Guillamondegui O, Paulino AF, Huvos AG (1999) Pattern of invasion and margin assessment in patients with oral tongue cancer. Head Neck 21:408–413
Acknowledgement
Dr Sannapaneni Krishnaiah (Biostatistian) for professional statistical help in this study.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gokavarapu, S., Chandrasekhara Rao, L.M., Patnaik, S.C. et al. Prognostic Value of Frozen Section in T1, T2 Carcinoma of Oral Cavity. Indian J Otolaryngol Head Neck Surg 67 (Suppl 1), 86–90 (2015). https://doi.org/10.1007/s12070-014-0783-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12070-014-0783-6