Intraoperative gross examination vs frozen section for achievement of adequate margin in oral cancer surgery.
OBJECTIVE
Surgical margin status is an important prognostic factor in oral squamous cell carcinoma. The primary aim of the surgeon is to achieve a microscopically complete surgical resection during initial surgery. As there are no definite guidelines, a few surgeons use frozen section (FS) for margin assessment whereas others use gross examination (GE).


METHODS
This is a retrospective analysis of prospectively collected data from the electronic medical records of 435 oral cavity cancer patients. As per the operating surgeon's preference, margin assessment was done using GE in 239 (54.94%) specimens, and FS was used in 196 (45.05%) specimens. Surgery was the primary modality of treatment for all patients, followed by adjuvant therapy.


RESULTS
Close/positive margins were seen in 6.63% of patients in the FS group and in 6.69% of patients in the GE group (P = .855). The sensitivity and specificity were 45.45% and 98.8%, respectively, for FS and 61.9% and 88.32% for GE. We found no survival benefit when FS was used for margin assessment (disease-free survival: P = .469; overall survival: 0.325). Incidence of inadequate margins was similar in both the groups (P = .608) even in patients with some form of previous treatment.


CONCLUSIONS
We propose the judicious use of FS rather than routine use for margin assessment. The study reports that GE is an well-tolerated oncologic alternative to FS.
Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India.
Manish
M
Mair
Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India.
Deepa
D
Nair
Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India.
Sudhir
S
Nair
Consultant, Narayana Hospital, Tata Memorial Hospital, Mumbai, India.
Sourav
S
Dutta
Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India.
Apoorva
A
Garg
Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India.
Akshat
A
Malik
Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India.
Aseem
A
Mishra
Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India.
Rathan
R
Shetty Ks
Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India. Electronic address: Chaturvedi.pankaj@gmail.com.
Pankaj
P
Chaturvedi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D019647:Oral Surgical Procedures; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity