Premium
Critical evaluation of frozen section margins in head and neck cancer resections
Author(s) -
Black Candice,
Marotti Jonathan,
Zarovnaya Elena,
Paydarfar Joseph
Publication year - 2006
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22347
Subject(s) - medicine , frozen section procedure , head and neck , head and neck cancer , surgical pathology , surgical margin , margin (machine learning) , radiology , surgery , radiation therapy , resection , machine learning , computer science
BACKGROUND. Negative resection margins are likely the most important prognostic factor for a patient with a head and neck squamous cell carcinoma. Frozen‐section evaluation allows a positive margin to be corrected before surgical closure and reconstruction. A final pathology report is later issued after examination of all resected tissues. The accuracy of the final pathology report relies on accuracy in the preceding steps. The current process of margin reporting in head and neck cancer resections was studied to reveal possible waste and error in the system. METHODS. Two hundred pathologists were surveyed about their center's current process of frozen‐section margin evaluation. The authors of the current study used the membership log of the North American Society of Head and Neck Pathology and the list of the top 50 US cancer centers according to US News and World Report. The authors analyzed the process of frozen‐section procedure using Toyota industry principles of quality improvement. RESULTS. The majority of surgeons send small fragments of tissue from the surgical defect cavity. Many pathologists receive small unoriented tissue fragments. Many resample all or most of the margins for the final pathology report without anatomic orientation from the surgeon. Other pathologists do not sample any margins. CONCLUSIONS. Final margin reporting redundancy and waste is due mainly to lack of anatomic correlation at interdisciplinary hand‐offs. Oversampling and undersampling of margins may be occurring, and the accuracy of the final pathology report may be compromised. There is currently no consensus on how to best submit tissue for frozen‐section evaluation of head and neck resection margins. Cancer 2006. © 2006 American Cancer Society.