title: Recent technological developments: in situ histopathological interrogation of surgical tissues and resection margins.
abstract: OBJECTIVE
  The tumour margin is an important surgical concept significantly affecting patient morbidity and mortality. We aimed in this prospective study to apply the microendoscope on tissue margins from patients undergoing surgery for oral cancer in vivo and ex vivo and compare it to the gold standard "paraffin wax", inter-observer agreement was measured; also to present the surgical pathologist with a practical guide to the every day use of the microendoscope both in the clinical and surgical fields.
  
  
  METHODS
  Forty patients undergoing resection of oral squamous cell carcinoma were recruited. The surgical margin was first marked by the operator followed by microendoscopic assessment. Biopsies were taken from areas suggestive of close or positive margins after microendoscopic examination. These histological samples were later scrutinized formally and the resection margins revisited accordingly when necessary.
  
  
  RESULTS
  Using the microendoscope we report our experience in the determination of surgical margins at operation and later comparison with frozen section and paraffin section margins "gold standard". We were able to obtain a sensitivity of 95% and a specificity of 90%. Inter-observer Kappa scores comparing the microendoscope with formal histological analysis of normal and abnormal mucosa were 0.85.
  
  
  CONCLUSIONS
  The advantage of this technique is that a large area of mucosa can be sampled and any histomorphological changes can be visualized in real time allowing the operator to make important informed decisions with regards the intra-operative resection margin at the time of the surgery.
authors.affiliation: Department of Head & Neck Surgery, the Royal Marsden Hospital, London, UK. mrtupile@yahoo.com
authors.forename: Tahwinder
authors.initials: T
authors.lastname: Upile
authors.forename: Cyril
authors.initials: C
authors.lastname: Fisher
authors.forename: Waseem
authors.initials: W
authors.lastname: Jerjes
authors.forename: Mohammed
authors.initials: M
authors.lastname: El Maaytah
authors.forename: Sandeep
authors.initials: S
authors.lastname: Singh
authors.forename: Holger
authors.initials: H
authors.lastname: Sudhoff
authors.forename: Adam
authors.initials: A
authors.lastname: Searle
authors.forename: Daniel
authors.initials: D
authors.lastname: Archer
authors.forename: Leslie
authors.initials: L
authors.lastname: Michaels
authors.forename: Colin
authors.initials: C
authors.lastname: Hopper
authors.forename: Peter
authors.initials: P
authors.lastname: Rhys-Evans
authors.forename: David
authors.initials: D
authors.lastname: Howard
authors.forename: Anthony
authors.initials: A
authors.lastname: Wright
mesh_terms: D001706:Biopsy; D016009:Chi-Square Distribution; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome