title: Efficacy of bone marrow cytologic evaluations in detecting occult cancellous invasion.
abstract: OBJECTIVE
  Determine the accuracy of bone marrow cytologic evaluations in detecting occult cancellous invasion by squamous cell carcinomas (SCCa) beyond the original margins of bone resection that would have gone undetected without the use of intraoperative bone-marrow margin analysis.
  
  
  METHODS
  Retrospective single institution cohort study.
  
  
  METHODS
  Retrospective chart review of imaging, clinical, pathological, and follow-up data of 51 patients who underwent mandibular resections with intraoperative bone-marrow cytologic evaluation. The accuracy of bone marrow cytologic evaluations to predict final bone margins was calculated. Five-year survival rates were determined.
  
  
  RESULTS
  The accuracy of bone marrow cytologic evaluations in detecting occult cancellous invasion by SCCa beyond the original margins of bone resection was 100%. Twelve percent (6/51) were found to have positive bone margins on cytology and were re-resected to obtain clear margins. Patients with a prior history of radiation had a significantly higher incidence of initially positive bone-marrow margins (P = 0.03). The patients with initially positive bone-margins did not have a significantly different prognosis than the patients with initially negative bone-marrow margins.
  
  
  CONCLUSIONS
  1) The consistent use of intraoperative bone-marrow cytologic evaluation, when applicable, will improve the ability to obtain clear bone margins. 2) Patients with a history of prior radiation therapy have a significantly higher risk of having occult cancellous invasion of SCCa beyond the original margins of bone resection. 3) The prognosis of patients with initially positive bone-marrow margins is not significantly different than patients with initially negative bone-marrow margins.
  
  
  METHODS
  4.
authors.affiliation: Saint Louis University School of Medicine, Saint Louis, Missouri.
authors.forename: Arya W
authors.initials: AW
authors.lastname: Namin
authors.forename: Seth D
authors.initials: SD
authors.lastname: Bruggers
authors.forename: Bharat A
authors.initials: BA
authors.lastname: Panuganti
authors.forename: Kara M
authors.initials: KM
authors.lastname: Christopher
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Walker
authors.forename: Mark A
authors.initials: MA
authors.lastname: Varvares
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001854:Bone Marrow Cells / Q000473:pathology*; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Oral cancer; bone marrow; cancellous bone; cytologic evaluation; cytology; frozen sections; history of radiation; mandible; mandibular invasion; margins; radiation; squamous cell carcinoma