Abstract B37: Cytopathologic assessment of gloves and instruments after major head and neck surgery: Implications for intraoperative practices

Abstract

Abstract Introduction: The purpose of the present study was to investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials, promoting the dissemination of cancerous cells from existing tumors to previously unaffected regions of the body. Methods: Pilot prospective study over a 6-month period (April-August 2018) at Rush University Medical Center of glove and instrument washings from 15 high-risk head and neck cancer resection cases (30 samples total). Each case maintained at least one of the following features in addition to a biopsy-proven diagnosis of squamous cell carcinoma or sarcoma of the head and neck: palliative surgery or salvage surgery, positive initial or final margins, extensive tumor burden, and/or extracapsular extension (ECE). After completion of each ablative procedure, surgical gloves of the primary surgeon and the four main surgical instruments in direct contact with the tumor were placed through washings for cytologic assessment (2 samples per case). Tumor and case characteristics were recorded. Samples were blindly evaluated by a board-certified cytopathologist for cytologic assessment. Results: 15 patients (11 males, 4 females, average age 65.13 years) undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned additional characteristics were included in the study. 26.7% of cases had ECE, 40.0% of cases had positive final margins, and 46.7% of cases had close final margins. Resected tumor locations included the oral cavity (7 cases), neck (4 cases), parotid gland (2 cases), and skin (2 cases). Malignant cells were isolated on glove washings in 1 case (6.7% of cases). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin contamination were isolated from 93.3% of instrument washings and 93.3% of glove washings. These squamous cells were differentiated from mature cells of the oral cavity by the absence of nuclei. Conclusions: Malignant squamous cells can be isolated from surgical glove washings. This supports the common practice of changing gloves during major head and neck cancer resections and may have important implications for intraoperative practices. Additional investigation is needed to assess for viability of detected malignant cells. Citation Format: Hannah N. Kuhar, Aryan Shay, Peter C. Revenaugh, Kerstin Stenson, Bobby Tajudeen, Paolo Gattuso, Samer Al-Khudari. Cytopathologic assessment of gloves and instruments after major head and neck surgery: Implications for intraoperative practices [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B37.