Division of Dermatology, Wexner Medical Center, The Ohio State University, Columbus, OH.
The Ohio State University College of Medicine, Columbus, OH.
Dermatol Surg. 2021 May 1;47(5):599-604. doi: 10.1097/DSS.0000000000002932.
Limited literature exists regarding whether intraoperative analysis of frozen debulk specimens during Mohs micrographic surgery (MMS) improves identification of high-risk features (HRF) of cutaneous squamous cell carcinoma (CSCC).
Primary: identification of new HRF on debulk specimens. Secondary: CSCC upstaged after considering debulk data.
A single-center, retrospective cohort study of patients with biopsy-proven CSCC treated by MMS with intraoperative frozen debulk analysis. Restricted (poor differentiation, new perineural invasion ≥0.1 mm, and Breslow depth >6 mm) and nonrestricted (any worsened tumor differentiation, any new perineural invasion, and Breslow depth >2 mm) analyses were performed.
In restricted analysis, 3.94% of cases had 1 new HRF on debulk analysis. In nonrestricted analysis, 32.9% of cases had ≥1 new HRF; 7.6% increased by 2 HRF. Approximately 2.0% of cases were upstaged by American Joint Committee on Cancer system, eighth edition criteria, 1.4% by Brigham and Women's Hospital. Tumor size ≥2 cm, male sex, and moderate differentiation on biopsy were significantly associated with new HRF identified on debulk analysis.
Intraoperative frozen debulk analysis can reveal HRF of CSCC not seen on biopsy or MMS stages, particularly among tumors ≥2 cm. American Joint Committee on Cancer system, eighth edition T2 tumors were most likely to be upstaged. Identification of new HRF on debulk analysis can improve CSCC staging and may impact patient treatment and follow-up.
关于在 Mohs 显微外科手术 (MMS) 中对冷冻减瘤标本进行术中分析是否能提高皮肤鳞状细胞癌 (CSCC) 的高危特征 (HRF) 识别能力，相关文献有限。
主要目的：识别减瘤标本上的新 HRF。次要目的：考虑减瘤数据后 CSCC 升级。
一项单中心回顾性队列研究，纳入了经 MMS 治疗的活检证实为 CSCC 的患者，这些患者在术中进行了冷冻减瘤分析。进行了受限（分化差、新的神经周围侵犯≥0.1mm 和 Breslow 深度>6mm）和非受限（任何肿瘤分化恶化、任何新的神经周围侵犯和 Breslow 深度>2mm）分析。
在受限分析中，3.94%的病例在减瘤分析中有 1 个新的 HRF。在非受限分析中，32.9%的病例有≥1 个新的 HRF；7.6%的病例增加了 2 个 HRF。约 2.0%的病例根据美国癌症联合委员会第八版分期标准，1.4%的病例根据 Brigham and Women's Hospital 分期被升级。肿瘤大小≥2cm、男性、活检时中度分化与减瘤分析中发现的新 HRF 显著相关。
术中冷冻减瘤分析可以揭示活检或 MMS 分期中未发现的 CSCC HRF，特别是在肿瘤≥2cm 的情况下。美国癌症联合委员会第八版 T2 肿瘤最有可能被升级。减瘤分析中新 HRF 的识别可以提高 CSCC 的分期，并可能影响患者的治疗和随访。
