Recent technological developments: in situ histopathological interrogation of surgical tissues and resection margins.
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.
Upile
Tahwinder
T
Department of Head & Neck Surgery, the Royal Marsden Hospital, London, UK. mrtupile@yahoo.com
Fisher
Cyril
C
Jerjes
Waseem
W
El Maaytah
Mohammed
M
Singh
Sandeep
S
Sudhoff
Holger
H
Searle
Adam
A
Archer
Daniel
D
Michaels
Leslie
L
Hopper
Colin
C
Rhys-Evans
Peter
P
Howard
David
D
Wright
Anthony
A
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