Nieberler M, Häußler P, Kesting M R, Kolk A, Stimmer H, Nentwig K, Weirich G, Wolff K-D
Department of Oral and Maxillofacial Surgery, Hospital rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679 Munich, Germany.
Department of Oral and Maxillofacial Surgery, Hospital rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679 Munich, Germany.
Br J Oral Maxillofac Surg. 2017 Jun;55(5):510-516. doi: 10.1016/j.bjoms.2017.02.006. Epub 2017 Mar 11.
The intraoperative cytological assessment of bony resection margins (ICAB) is a feasible diagnostic approach to support frozen section for assessment of invasion of margins of soft and hard tissue. However, complex resection margins could challenge both diagnostic approaches. Our objective here was to identify the limitations of intraoperative diagnostic methods for assessing margins. We present an advanced cytological approach to assess complex margins that may solve the problem. Data from 119 patients in whom frozen section was supported by ICAB, were reviewed and the reasons for false results analysed. In 35 patients with squamous cell carcinoma infiltrating bone, specimens (n=100) from the resection margin went through an intraoperative cell isolation process for the cytological assessment of bony margins (ICAB). The results were compared with the histological results of the corresponding margins of bone as a reference. Limitations to the assessment of operative bony margins intraoperatively included an infiltrative histological pattern of growth of the carcinoma, with carcinoma cells disseminated within the cancellous bone, complex and uneven resection margins with soft and bony tissue, inflammation, and signs of previous radiotherapy. Intraoperative cell isolation plus (ICICAB) allowed the microscopic assessment of up to 1cm of bony tissue to detect disseminated carcinoma cells within the cancellous bone with a sensitivity of 92.3% (95% CI 74.9% to 99.1%), and a specificity of 100% (95% CI 95.1% to 100%), and positive and negative predictive values of 100% (95% CI 85.8% to 100%) and 97.4% (95%CI 90.8% to 99.7%), respectively. Intraoperative cell isolation is a feasible new technique to support ICAB and frozen section in the assessment of bony and soft tissue margins.
骨切除边缘的术中细胞学评估（ICAB）是一种可行的诊断方法，可辅助冰冻切片评估软硬组织边缘的浸润情况。然而，复杂的切除边缘可能对这两种诊断方法都构成挑战。我们在此的目的是确定评估边缘的术中诊断方法的局限性。我们提出了一种先进的细胞学方法来评估复杂边缘，这可能解决该问题。回顾了119例由ICAB辅助冰冻切片的患者的数据，并分析了结果错误的原因。在35例鳞状细胞癌浸润骨的患者中，来自切除边缘的标本（n = 100）经过术中细胞分离过程，用于骨边缘的细胞学评估（ICAB）。将结果与相应骨边缘的组织学结果作为参考进行比较。术中评估手术骨边缘的局限性包括癌的浸润性组织学生长模式，癌细胞散布在松质骨内，软硬组织复杂且不均匀的切除边缘，炎症以及既往放疗的迹象。术中细胞分离加（ICICAB）可对长达1cm的骨组织进行显微镜评估，以检测松质骨内散布的癌细胞，灵敏度为92.3％（95％CI 74.9％至99.1％），特异性为100％（95％CI 95.1％至100％），阳性和阴性预测值分别为100％（95％CI 85.8％至100％）和97.4％（95％CI 90.8％至99.7％）。术中细胞分离是一种可行的新技术，可在评估骨和软组织边缘时辅助ICAB和冰冻切片。
