ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
Department of Otolaryngology, Mayo Clinic Phoenix, Phoenix, Arizona.
Oral Dis. 2019 Jul;25(5):1309-1317. doi: 10.1111/odi.13101. Epub 2019 Apr 21.
Although the reliability of frozen sections for the intraoperative assessment of complete tumour excision has been established, the best location for collection and the impact of the type of sampling are still debated. We retrospectively investigated the reliability of frozen sections when collected from the surgical bed as tissue strips representative of the whole superficial margin and as a bowl of tissue underlying the resection site for deep margin, and the possibility of relying on frozen section negativity to consider resections complete.
Frozen section reliability was calculated by comparing histology before and after formalin embedding and then categorised by sampling type, in 182 patients undergoing transoral resection of oral cancer.
Comparing frozen and permanent histology, sensitivity, specificity and accuracy were 69%, 98% and 96%, respectively; categorisation by sampling type failed to produce statistically significant differences. Based on frozen section negativity after formalin embedding, complete resections were obtained in 91.7% of patients with multiple-strip and bowl frozen sections.
Frozen sections collected as tissue strips and bowl are as reliable as point sampling in the intraoperative guidance of surgical resections. They effectively provide for margin enlargement, thereby increasing the surgeon's confidence that negative margins are clear.
尽管冰冻切片在术中评估肿瘤完全切除的可靠性已经得到证实，但采集的最佳位置和采样类型的影响仍存在争议。我们回顾性研究了从手术床采集的冰冻切片的可靠性，这些切片作为代表整个浅层切缘的组织条带和作为切除部位下方的组织碗，用于深层切缘，以及依赖冰冻切片阴性来认为切除完整的可能性。
在 182 名接受经口切除口腔癌的患者中，通过比较福尔马林包埋前后的组织学，计算冰冻切片的可靠性，然后根据采样类型进行分类。
将冰冻切片和石蜡切片的组织学进行比较，敏感性、特异性和准确性分别为 69%、98%和 96%；根据采样类型的分类未产生统计学上的显著差异。基于福尔马林包埋后的冰冻切片阴性，采用多点和碗状冰冻切片，91.7%的患者获得了完全切除。
作为组织条带和碗状采集的冰冻切片与术中指导手术切除的点样一样可靠。它们有效地提供了切缘扩大，从而增加了外科医生对切缘无肿瘤的信心。
