Mair Manish, Nair Deepa, Nair Sudhir, Dutta Sourav, Garg Apoorva, Malik Akshat, Mishra Aseem, Shetty Ks Rathan, Chaturvedi Pankaj
Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India.
Consultant, Narayana Hospital, Tata Memorial Hospital, Mumbai, India.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 May;123(5):544-549. doi: 10.1016/j.oooo.2016.11.018. Epub 2016 Dec 7.
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).
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.
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.
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.
手术切缘状态是口腔鳞状细胞癌的一个重要预后因素。外科医生的主要目标是在初次手术时实现显微镜下的完整手术切除。由于没有明确的指导方针，一些外科医生使用冰冻切片（FS）进行切缘评估，而另一些医生则使用大体检查（GE）。
这是一项对前瞻性收集的435例口腔癌患者电子病历数据的回顾性分析。根据手术医生的偏好，239例（54.94%）标本使用GE进行切缘评估，196例（45.05%）标本使用FS。手术是所有患者的主要治疗方式，其次是辅助治疗。
FS组6.63%的患者和GE组6.69%的患者出现切缘接近/阳性（P = 0.855）。FS的敏感性和特异性分别为45.45%和98.8%，GE的敏感性和特异性分别为61.9%和88.32%。我们发现使用FS进行切缘评估时没有生存获益（无病生存：P = 0.469；总生存：0.325）。即使在接受过某种形式既往治疗的患者中，两组切缘不充分的发生率也相似（P = 0.608）。
我们建议明智地使用FS而非常规用于切缘评估。该研究报告称，GE是一种耐受性良好的FS肿瘤学替代方法。
