Nieberler Markus, Häußler Patrick, Kesting Marco Rainer, Kolk Andreas, Deppe Herbert, Weirich Gregor, Wolff Klaus-Dietrich
Department of Oral and Maxillofacial Surgery, Hospital rechts der Isar, Technische Universität München, Munich, Germany.
Institute of Pathology, Technische Universität München, Munich, Germany.
Ann Surg Oncol. 2016 Oct;23(11):3579-3586. doi: 10.1245/s10434-016-5208-1. Epub 2016 Mar 25.
Surgical treatment of head and neck squamous cell carcinoma (HNSCC) patients often results in complex defects, affecting functional structures. Frozen sections are valuable to guide resections and control for adequate margins; however, intraoperative assessment of bone remains challenging.
The objective of this study was to evaluate the clinical impact of an intraoperative cytological assessment of bone margins (ICAB) on resection status and patient outcome.
ICAB analysis (n = 267) was implemented in 102 patients during resection of HNSCC for a guided resection of affected bone. The cytological findings were compared with the final histological results of the corresponding bone margins, and the surgical consequences, R1 rates, and patient outcome of the ICAB intervention group were compared with an equal control group of 100 patients.
ICAB revealed a sensitivity of 94.4 % [95 % confidence interval (CI) 81.3-99.3], specificity of 97.4 % (95 % CI 94.4-99.0), positive predictive value of 85.0 % (95 % CI 70.2-94.3), and negative predictive value of 99.1 % (95 % CI 96.9-99.9). Osseous R1 resections were reduced from 8 to 2.9 % (∆R1 = 5.1 %; p = 0.113), rendering a relative risk reduction (RRR) of 63.2 % with a number needed to treat (NNT) of 19.57. ICAB influenced final resection status, with a reduction of R1 resections from 17 to 7.8 % (∆R1 = 9.2 %; p = 0.026), with an RRR of 59.65 % and an NNT of 9.66. The ICAB intervention group revealed a higher disease-free survival [p(log-rank) = 0.045] and overall survival [p(log-rank) = 0.014] according to multivariable analysis.
ICAB, applied as a routine diagnostic tool to supplement frozen sections, can help to reduce R1 resections in order to improve patient outcome.
头颈部鳞状细胞癌（HNSCC）患者的手术治疗常常导致复杂的缺损，影响功能结构。冰冻切片对于指导切除和控制切缘是否足够很有价值；然而，术中对骨组织的评估仍然具有挑战性。
本研究的目的是评估术中骨切缘细胞学评估（ICAB）对切除状态和患者预后的临床影响。
在102例HNSCC切除术中实施ICAB分析（n = 267），以指导对受累骨组织的切除。将细胞学检查结果与相应骨切缘的最终组织学结果进行比较，并将ICAB干预组的手术后果、R1切除率和患者预后与100例患者的同等对照组进行比较。
ICAB显示敏感性为94.4%[95%置信区间（CI）81.3 - 99.3]，特异性为97.4%（95%CI 94.4 - 99.0），阳性预测值为85.0%（95%CI 70.2 - 94.3），阴性预测值为99.1%（95%CI 96.9 - 99.9）。骨组织R1切除率从8%降至2.9%（ΔR1 = 5.1%；p = 0.113），相对危险度降低（RRR）为63.2%，需治疗人数（NNT）为19.57。ICAB影响最终切除状态，R1切除率从17%降至7.8%（ΔR1 = 9.2%；p = 0.026），RRR为59.65%，NNT为9.66。根据多变量分析，ICAB干预组显示出更高的无病生存率[p（对数秩）= 0.045]和总生存率[p（对数秩）= 0.014]。
ICAB作为一种常规诊断工具用于补充冰冻切片，有助于减少R1切除，从而改善患者预后。
