title: Critical evaluation of frozen section margins in head and neck cancer resections.
abstract: BACKGROUND
  Negative resection margins are likely the most important prognostic factor for a patient with a head and neck squamous cell carcinoma. Frozen-section evaluation allows a positive margin to be corrected before surgical closure and reconstruction. A final pathology report is later issued after examination of all resected tissues. The accuracy of the final pathology report relies on accuracy in the preceding steps. The current process of margin reporting in head and neck cancer resections was studied to reveal possible waste and error in the system.
  
  
  METHODS
  Two hundred pathologists were surveyed about their center's current process of frozen-section margin evaluation. The authors of the current study used the membership log of the North American Society of Head and Neck Pathology and the list of the top 50 US cancer centers according to US News and World Report. The authors analyzed the process of frozen-section procedure using Toyota industry principles of quality improvement.
  
  
  RESULTS
  The majority of surgeons send small fragments of tissue from the surgical defect cavity. Many pathologists receive small unoriented tissue fragments. Many resample all or most of the margins for the final pathology report without anatomic orientation from the surgeon. Other pathologists do not sample any margins.
  
  
  CONCLUSIONS
  Final margin reporting redundancy and waste is due mainly to lack of anatomic correlation at interdisciplinary hand-offs. Oversampling and undersampling of margins may be occurring, and the accuracy of the final pathology report may be compromised. There is currently no consensus on how to best submit tissue for frozen-section evaluation of head and neck resection margins.
authors.affiliation: Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. Candice.C.Black@hitchcock.org
authors.forename: Candice
authors.initials: C
authors.lastname: Black
authors.forename: Jonathan
authors.initials: J
authors.lastname: Marotti
authors.forename: Elena
authors.initials: E
authors.lastname: Zarovnaya
authors.forename: Joseph
authors.initials: J
authors.lastname: Paydarfar
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D003625:Data Collection; D005629:Frozen Sections / Q000592:standards*; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D011379:Prognosis