Sapsford Timothy, Wilson Zachary, Anderson Daniel
Otolaryngology Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia.
School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
Sci Prog. 2025 Apr-Jun;108(2):368504251344182. doi: 10.1177/00368504251344182. Epub 2025 May 19.
ObjectiveKeratinocyte cancers (KCs) account for significant healthcare burden in regional Australia. Effective surgical management relies on accurate pre-operative biopsy to inform risk status and guide clinical excision margins. Through retrospective analysis, we aim to describe correlation rates of pre-operative biopsy and final pathology in head and neck KC excisions.MethodsFrom July 2023 to June 2024, 137 KC excisions performed in a regional Australian Otolaryngology Head and Neck surgery outpatient skin unit were analysed. Patient demographics, lesion characteristics, preoperative biopsy, and final histopathology were examined.ResultsExcisions were undertaken for 101 basal cell carcinomas (BCCs), 30 squamous cell carcinomas (SCCs), and six intra-epidermal carcinomas. Nineteen excisions were performed without pre-operative biopsy and 15 further excisions were re-excisions for close or involved margins and were not included in correlation analysis. Of the remaining 97 KC, there was concordance between biopsy and formal pathology risk status in 47.4%. Upgraded (higher) risk formal pathology was reported in 19.6% while downgraded (lower) risk formal pathology was reported in 8.2%. Within the higher risk group, three BCC excisions reported close margins when their lower risk subtype (if confirmed) would have been considered clear. There was no residual malignancy in 24.7% of KC excisions. Pathologic concordance rates after subgroup analysis were 58.7% for BCCs and 9.1% for SCCs.ConclusionAccurate pre-operative biopsy to guide treatment options and inform clinical margins is especially important for head and neck KCs, where functional and cosmetic constraints are greatest. The correlation rate for surgically excised head and neck KCs has not been previously investigated in the Australian regional setting. This work highlights the importance of counselling patients on the potential for higher risk final pathology when discussing the risk of requiring further treatment.
目的
在澳大利亚部分地区，角质形成细胞癌（KCs）给医疗保健带来了沉重负担。有效的手术管理依赖于准确的术前活检，以告知风险状况并指导临床切除边缘。通过回顾性分析，我们旨在描述头颈部KC切除术中术前活检与最终病理的符合率。
方法
对2023年7月至2024年6月在澳大利亚某地区耳鼻喉头颈外科门诊皮肤单元进行的137例KC切除术进行分析。检查了患者的人口统计学资料、病变特征、术前活检和最终组织病理学。
结果
共进行了101例基底细胞癌（BCC）、30例鳞状细胞癌（SCC）和6例表皮内癌的切除。19例切除未进行术前活检，另有15例切除是因切缘接近或受累而进行的再次切除，未纳入相关性分析。在其余97例KC中，活检与正式病理风险状况的符合率为47.4%。19.6%的病例报告正式病理风险升级（更高），8.2%的病例报告正式病理风险降级（更低）。在高风险组中，3例BCC切除报告切缘接近，而如果其低风险亚型（如果得到证实）本应被视为切缘阴性。24.7%的KC切除术中无残留恶性肿瘤。亚组分析后，BCC的病理符合率为58.7%，SCC为9.1%。
结论
准确的术前活检以指导治疗方案并告知临床切缘，对于头颈部KC尤为重要，因为此处功能和美容限制最大。此前在澳大利亚地区环境中尚未对头颈部手术切除的KC的符合率进行过研究。这项工作强调了在讨论需要进一步治疗的风险时，向患者咨询最终病理风险可能更高的重要性。
