Ord R A, Aisner S
Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore 21201-1586, USA.
J Oral Maxillofac Surg. 1997 Jul;55(7):663-9; discussion 669-71. doi: 10.1016/s0278-2391(97)90570-x.
This study examined the accuracy of frozen section diagnosis of tissue samples from surgical margins compared with the final histologic diagnosis of the same tissue. The total resection specimen was also examined to see whether frozen sections were helpful in predicting negative margins for the entire cancer. The nature of positive and negative margins and their implications for the surgeon are discussed.
The records of 49 consecutive patients with previously untreated squamous carcinoma of the mouth were reviewed. All frozen and permanent sections were evaluated by one pathologist. Margins involved by carcinoma, carcinoma in situ, dysplasia, or with carcinoma within 5 mm were defined as positive. Histologic findings were compared with the patient's clinical course to define the relationship between positive margins and local recurrence. Patients were followed for 17 to 45 months or until death.
Three hundred four of 307 frozen sections showed concordance with the permanent section of the same tissue sample (two false negative and one false positive), an accuracy rate of 99%. When the final margins of the resected surgical specimen were compared with the frozen section diagnoses, ten patients had positive final margins. In three patients, these were diagnosed by frozen section. Seven patients had final margins that were positive when the surgical resection specimen was examined but were not diagnosed by frozen section. A greater local recurrence note was found in patients with invasive carcinoma at the margin, dysplastic margins, and margins within 5 mm of the cancer.
Although frozen sections are extremely accurate, they are not as reliable in eliminating positive margins in the final specimen as the surgeon might hope.
本研究将手术切缘组织样本的冰冻切片诊断结果与同一组织的最终组织学诊断结果进行对比，以检验其准确性。还对完整切除标本进行检查，观察冰冻切片是否有助于预测整个癌灶的阴性切缘。探讨了阳性和阴性切缘的性质及其对外科医生的意义。
回顾了49例既往未经治疗的口腔鳞状细胞癌患者的病历。所有冰冻切片和永久切片均由一名病理学家评估。癌灶累及、原位癌、发育异常或距癌灶5毫米内有癌的切缘定义为阳性。将组织学检查结果与患者的临床病程进行比较，以明确阳性切缘与局部复发之间的关系。对患者进行了17至45个月的随访或直至死亡。
307份冰冻切片中有304份与同一组织样本的永久切片结果一致（2例假阴性和1例假阳性），准确率为99%。将切除手术标本的最终切缘与冰冻切片诊断结果进行比较时，10例患者的最终切缘为阳性。其中3例经冰冻切片诊断。7例患者手术切除标本检查时最终切缘为阳性，但冰冻切片未诊断出来。切缘有浸润性癌、发育异常切缘以及距癌灶5毫米内切缘的患者局部复发率更高。
尽管冰冻切片极为准确，但在排除最终标本中的阳性切缘方面，其可靠性不如外科医生期望的那样高。
