Meulemans Jeroen, Hauben Esther, Peeperkorn Samuel, Nuyts Sandra, Delaere Pierre, Vander Poorten Vincent
Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.
Section Head and Neck Oncology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium.
Front Surg. 2020 Aug 28;7:56. doi: 10.3389/fsurg.2020.00056. eCollection 2020.
The value of margin status after TLM for glottic cancer is debatable, due to difficulties in specimen orientation and margin analysis. Purpose of this study was the prospective evaluation of feasibility of a new standardized technique of oriented fixation of the TLM specimen and identification of the added value on tissue processing and margin status reporting. Patients with suspicious glottic lesions undergoing TLM were included. After resection, the specimen margins were inked in the OR using different colors. Subsequently, the specimens were fixed on a pig liver carrier and sent for further processing, accompanied with photographs of the larynx pre-TLM and of the mounted specimen. Feasibility was assessed by registration of duration of specimen preparation in the OR and the lab and by procedure-specific questionnaires. Objective evaluation included assessment of margin status and proportion of evaluable margins. Chi square tests were used to make comparisons of proportions. One hundred and four consecutive patients were included between May 2016 and September 2019. TLM was performed in a primary and salvage setting in 89.4 and 10.6% of patients, respectively. Mean duration of intraoperative specimen preparation was 5.1 min (SD 2.6 min). No difficulties in orientation nor fixation during intraoperative preparation were reported in 87.5 and 88.2%, respectively. Specimen orientation was judged by the pathologist as very adequate in 89.4%, with the accompanying photographs considered helpful for orientation and processing in 84.6%. Substantial difficulties in further lab processing and pathologic examination were identified in 17.7%. Deep margin evaluability was very high (98.0%) and significantly higher than the evaluability of superficial mucosal margins. Compared to our previous series published by our group ( = 142), deep margin evaluability significantly rose from 62.7 to 98.0% ( < 0.001) and true positive rate of the deep margins increased from 0 to 44.4% ( = 0.002). The new and standardized technique of oriented fixation of TLM specimens on a pig liver carrier proves feasible both in the OR and lab setting and results in high margin evaluability rates, especially for the deep margin, as well as a decreased rate of false positive deep margins when compared to a historical TLM cohort.
由于标本定位和切缘分析存在困难，对于声门癌患者而言，在激光显微手术（TLM）后切缘状态的价值存在争议。本研究的目的是前瞻性评估一种新的标准化技术，即对TLM标本进行定向固定的可行性，并确定其在组织处理和切缘状态报告方面的附加价值。纳入接受TLM的可疑声门病变患者。切除后，在手术室使用不同颜色对标本切缘进行标记。随后，将标本固定在猪肝载体上并送去进一步处理，同时附上TLM术前喉部及固定后标本的照片。通过记录手术室和实验室中标本制备的持续时间以及特定程序问卷来评估可行性。客观评估包括切缘状态评估和可评估切缘的比例。使用卡方检验进行比例比较。2016年5月至2019年9月期间连续纳入104例患者。分别在89.4%和10.6%的患者中，TLM用于初次治疗和挽救性治疗。术中标本制备的平均持续时间为5.1分钟（标准差2.6分钟）。分别有87.5%和88.2%的患者报告术中制备过程中在定位和固定方面没有困难。病理学家判定标本定位非常合适的比例为89.4%，84.6%的人认为附带的照片有助于定位和处理。17.7%的患者在进一步的实验室处理和病理检查中发现存在重大困难。深部切缘的可评估性非常高（98.0%），且显著高于浅表黏膜切缘的可评估性。与我们团队之前发表的系列研究（n = 142）相比，深部切缘的可评估性从62.7%显著提高到98.0%（P < 0.001），深部切缘的真阳性率从0增加到44.4%（P = 0.002）。将TLM标本在猪肝载体上进行定向固定的新标准化技术在手术室和实验室环境中均被证明是可行的，并且切缘可评估率很高，尤其是深部切缘，与历史TLM队列相比，深部切缘假阳性率降低。
