Accuracy of Histological Examination following Endoscopic CO2 Laser-Assisted Laryngectomy

Abstract

We reviewed 242 cordectomy or supraglottic laryngectomy cases operated since 1989. The vocal fold epithelium removed during subepithelial cordectomy with diagnostic intent or biopsies of the operative site after tumor resection underwent frozen section examination. However, the surgical specimen never underwent frozen section analysis. Conventionally, the histopathologist examined the margin area free of laser coagulation. Using the Acuspot micromanipulator alone, coagulation depth was less than or equal to 100 µm; with the Acublade, it was less then 20 µm. Of 181 frozen sections, 154 (85.1%) had negative margins, 23 (12.7%) had positive margins and 1 (0.6%) had moderate dysplasia of the section margin. Reading was inconclusive in 2 cases (1.1%) and impossible in 1 (0.6%). The second examination of the margins during examination of the surgical specimen did not reveal false-positive or false-negative results. Of the 23 patients with positive resection margins at frozen section analysis, 8 (34.8%) underwent immediate and more extensive cordectomy. Frozen section analysis is reliable and cost-effective in oncology for endoscopic partial laryngectomy.