Evaluation of intraoperative cytological assessment of bone resection margins in patients with oral squamous cell carcinoma. Issue 9 (18th April 2014)

• Record Type: Journal Article
• Authors: Nieberler, Markus; Häusler, Patrick; Drecoll, Enken; Stoeckelhuber, Mechthild; Deppe, Herbert; Hölzle, Frank; Kolk, Andreas; Wolff, Klaus‐Dietrich; Kesting, Marco Rainer; Weirich, Gregor
• Is Part Of: Cancer cytopathology. Volume 122:Issue 9(2014:Sep.)
• Page Start: 646
• Page End: 656
• Publication Date: 2014-04-18
• Subjects: oral cancer -- oral squamous cell carcinoma -- intraoperative cytology -- surgical margins -- bone margins -- bone infiltration; Cancer -- Cytopathology -- Periodicals; Pathology, Cellular -- Periodicals; Cytology -- Technique -- Periodicals; 611.01815
• DOI: 10.1002/cncy.21428
• Languages: English
• ISSNs: 1934-662X

Abstract

Abstract : BACKGROUND: Frozen sections are routinely applied to control for adequate resection margins. In cases in which carcinoma infiltrates bone, the intraoperative microscopic assessment of bone margins remains challenging due to technical difficulties to section native bone. The objective of the current study was to evaluate an intraoperative cytological approach to control bone resection margins in patients with bone‐infiltrating oral squamous cell carcinomas. METHODS: A total of 174 cytological preparations obtained from bone margins of bone‐infiltrating oral squamous cell carcinomas (28 patients) were assessed intraoperatively and compared with the corresponding histological findings. In a validation cohort (45 patients) the intraoperative cytological assessment of bone resection margins (ICAB) (104 margins) was evaluated as a diagnostic tool for routine clinical application. RESULTS: In the first patient cohort, the ICAB revealed 95.3% sensitivity and 96% specificity. The results provided an accuracy of 95.7% with a significant correlation noted between cytological and histological results (κ, 0.91; P < .001), and a positive predictive value and negative predictive value of 93.8% and 96.9%, respectively. In the validation cohort, ICAB revealed 80% sensitivity and 98.9% specificity with 98% accuracy. There was a significant correlation found between cytological and histological results (κ, 0.91; P < .001), providing a positive predictive value and negative predictive value of 80% and 98%, respectively. ICAB could predict final resection status at bone margins with 80% sensitivity and 97.5% specificity. A significant correlation was found between the cytological and histological resection status at bone margins (κ, 0, 75; P < .001). CONCLUSIONS: ICAB could supplement intraoperative frozen sections of soft tissue margins as a standard procedure to control for adequate resection at bone margins. Cancer (Cancer Cytopathol) 2014;122:646–656 . © 2014 American Cancer Society . Abstract : The current study evaluates the intraoperative cytological assessment of bone resection margins to control resection status in patients with bone‐infiltrating oral squamous cell carcinomas. The work demonstrates that intraoperative cytological assessment of bone resection margins could supplement the intraoperative assessment of soft tissue margins through the immediate microscopic control of bony resection margins, enabling a guided reresection of positive bone margins during a surgical intervention to optimize surgical concepts, especially for patients with carcinoma, who receive primary reconstruction with osteo‐(myo‐)cutaneous microvascular transplants.