Scholl P, Byers R M, Batsakis J G, Wolf P, Santini H
Am J Surg. 1986 Oct;152(4):354-60. doi: 10.1016/0002-9610(86)90304-1.
A retrospective review was carried out of the records of 268 patients with a pathologically proved diagnosis of squamous carcinoma of the tongue treated by glossectomy at M.D. Anderson Hospital and Tumor Institute from January 1, 1970 through December 31, 1979. Pathologic findings found on frozen section analysis were correlated with the TNM stage of the tumor, histologic characteristics, perineural invasion, type of treatment, local recurrence, and survival rate. Thirty-eight patients with squamous carcinoma of the oral tongue and 16 patients with tumors of the base of the tongue had initially positive frozen section margins. Forty-one of these patients had margins that were negative at the completion of surgery. Thirteen patients never had negative margins. Positive mucosal margins were more common in smaller tumors and positive muscular margins were more common in larger tumors. Patients with perineural invasion and larger tumors had a higher percentage of positive margins. Those patients with initially positive margins that were rendered negative at the completion of the procedure and treated with surgery only had a significantly increased local recurrence rate and reduced survival compared with patients similarly treated with initially negative margins. Tumor stage, location (muscular versus mucosal) of positive margins, and the presence of perineural invasion were not significant in predicting local recurrence or decreased survival. If all patients with microscopically positive margins are considered for postoperative radiotherapy, then the routine use of intraoperative frozen section examination of the margins of resection in squamous carcinoma of the tongue may not be justified.
对1970年1月1日至1979年12月31日在MD安德森医院和肿瘤研究所接受舌切除术治疗且病理确诊为舌鳞状癌的268例患者的病历进行了回顾性研究。将冰冻切片分析的病理结果与肿瘤的TNM分期、组织学特征、神经周围浸润、治疗类型、局部复发和生存率进行了关联分析。38例口腔舌鳞状癌患者和16例舌根肿瘤患者的冰冻切片切缘最初为阳性。其中41例患者在手术结束时切缘为阴性。13例患者切缘从未转阴。较小肿瘤中黏膜切缘阳性更为常见，较大肿瘤中肌肉切缘阳性更为常见。有神经周围浸润和较大肿瘤的患者切缘阳性的比例更高。那些最初切缘阳性但在手术结束时转为阴性且仅接受手术治疗的患者，与最初切缘阴性的类似治疗患者相比，局部复发率显著增加，生存率降低。肿瘤分期、阳性切缘的位置（肌肉与黏膜）以及神经周围浸润的存在对于预测局部复发或生存率降低并无显著意义。如果考虑对所有显微镜下切缘阳性的患者进行术后放疗，那么常规术中对舌鳞状癌切除切缘进行冰冻切片检查可能并无必要。
