title: Routine intraoperative frozen section analysis of bronchial margins is of limited utility in lung cancer resection.
abstract: BACKGROUND
  Residual disease at the bronchial margin after resection of non-small cell lung cancer (NSCLC) adversely affects survival. To ensure an R0 resection, thoracic surgeons commonly use intraoperative frozen section analysis of the bronchial margin. We hypothesize that frozen section of the bronchial margin is rarely positive and seldom changes intraoperative management.
  
  
  METHODS
  Our institutional Society of Thoracic Surgery database was queried for all patients undergoing planned lobectomy for NSCLC from 2009 to 2011. Clinical variables, intraoperative data, and postoperative outcomes were reviewed. Specifically, intraoperative frozen section and final pathology results of all bronchial margins were examined. The frequency that frozen section results affected intraoperative decision making was evaluated.
  
  
  RESULTS
  A total of 287 lobectomies for NSCLC were performed. Frozen section of the bronchial margin was performed in 270 patients (94.1%). There were 6 (2.2%) true-positive bronchial margins and 1 (0.4%) false-negative margin. In no cases did a positive frozen section lead to a change in operative management; reasons included unable to tolerate further resection (n = 5) and advanced-stage disease (n = 1). Positive margins were more frequent with open techniques (7%) than in video-assisted thoracoscopic operations (0.05%; p < 0.01). Tumors with positive margins were closer to the bronchial margin (1.0 vs 2.5 cm; p = 0.04). Frozen section was not used in 17 patients (5.9%), and none had positive margins on final pathology.
  
  
  CONCLUSIONS
  Frozen section analysis of the bronchial margin rarely yields a positive result and infrequently changes intraoperative management in patients undergoing NSCLC resection. These data support selective use of intraoperative frozen section of bronchial margins during lobectomy for NSCLC.
authors: Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors: Rachel M
authors: RM
authors: Owen
authors: Seth D
authors: SD
authors: Force
authors: Anthony A
authors: AA
authors: Gal
authors: Paul L
authors: PL
authors: Feingold
authors: Allan
authors: A
authors: Pickens
authors: Daniel L
authors: DL
authors: Miller
authors: Felix G
authors: FG
authors: Fernandez
mesh_terms: D000367:Age Factors; D000368:Aged; D001980:Bronchi / Q000473:pathology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D004502:Education, Medical, Continuing; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D061646:Operative Time; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome