Frozen Section Histopathology Research Articles

Abstract B042: Sentinel lymph node detection in breast cancer: Comparison of blue dye and filtered Technetium 99m sulphur colloid radiotracer injection

Abstract Aim: This prospective study was performed to compare the identification rate, sensitivity and specificity of blue dye and filtered Technetium 99m labelled sulphur colloid (Tc99m SC), individually and in combination for the detection of sentinel lymph nodes in clinically node negative early-stage breast cancer. Materials and methods: Thirty-two women with biopsy-proven breast cancer (cT1N0M0-T2N0M0) were included in this prospective study over a period of 18 months (2019-2020). Four peri-areolar intradermal injections of filtered Tc99m SC were administered 2-3 hours before surgery. Sequential dynamic anterior images of the chest were acquired on a gamma camera, followed by anterior and anterior oblique static images and hybrid single photon emission computed tomography / computed tomography (SPECT/CT) of the affected breast and ipsilateral axilla. Pre-operatively, the sites of detected sentinel lymph nodes (SLNs) were marked on the skin surface using a hand-held gamma probe. SLNs were then identified intra-operatively after peri-tumoral methylene blue injection (blue nodes) and with the gamma probe (hot nodes). These SLNs were removed and sent for frozen section histopathology separately, labelled as hot only, blue only and hot and blue. All patients underwent axillary lymph node dissection (ALND). The final histopathology of all lymph nodes excised during ALND and SLN biopsy were analysed. Identification rate, sensitivity and specificity of both the methods for SLN detection individually and in combination were compared. Results: SLN data of 32 female patients aged 54.7±10.6 years with cT1N0M0-T2N0M0 was analysed. In 87.5% of patients (n=28) the same lymph node was identified by blue dye and filtered Tc99m SC and discordance was seen in 12.5% (n=3) patients. No SLN was detected by any method in one patient. Identification rate of filtered Tc99m SC alone, blue dye alone and combination techniques was 96.9% (n=31), 93.8% (n=30) and 96.9% (n=31) respectively. Of total 593 dissected lymph nodes including 78 SLNs (average 2.4±1.7 per patient), metastasis was found in 198 lymph nodes (12/32 patients). The sensitivity and specificity of the procedure considering only filtered Tc99m SC, blue dye alone and combination of the two tracers was found to be 83.3% (95% CI of 51.6-97.9) and 100% (95% CI of 82.4-100), 75% (95% CI of 42.8- 94.5) and 100% (95% CI of 81.5 -100) and 83.3% (95% CI of 51.6-97.9) and 100% (95% CI of 82.4-100) respectively. Conclusion: SLNB with filtered Tc99m SC using the intra operative gamma probe has better identification rate and sensitivity than blue dye in detecting SLN, while preoperative SPECT/CT helped the surgeon to locate the SLN during surgery. Blue dye has a complementary role in identifying the SLN due to ease of visualisation while operating. Citation Format: Anish Bhattacharya, Yamini Mathur, Ishita Laroiya, Amanjeet Bal, Sarika Sharma, Bhagwant R. Mittal. Sentinel lymph node detection in breast cancer: Comparison of blue dye and filtered Technetium 99m sulphur colloid radiotracer injection [abstract]. In: Proceedings of the AACR Special Conference: Cancer Metastasis; 2022 Nov 14-17; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_2):Abstract nr B042.

Desorption electrospray ionization mass spectrometry imaging (DESI-MSI) in disease diagnosis: an overview.

Tissue analysis, which is essential to histology and is considered the benchmark for the diagnosis and prognosis of many illnesses, including cancer, is significant. During surgery, the surgical margin of the tumor is assessed using the labor-intensive, challenging, and commonly subjective technique known as frozen section histopathology. In the biopsy section, large numbers of molecules can now be visualized at once (ion images) following recent developments in [MSI] mass spectrometry imaging under atmospheric conditions. This is vastly superior to and different from the single optical tissue image processing used in traditional histopathology. This review article will focus on the advancement of desorption electrospray ionization mass spectrometry imaging [DESI-MSI] technique, which is label-free and requires little to no sample preparation. Since the proportion of molecular species in normal and abnormal tissues is different, DESI-MSI can capture ion images of the distributions of lipids and metabolites on biopsy sections, which can provide rich diagnostic information. This is not a systematic review but a summary of well-known, cutting-edge and recent DESI-MSI applications in cancer research between 2018 and 2023.

Novel rapid intraoperative qualitative tumor detection by a residual convolutional neural network using label-free stimulated Raman scattering microscopy

Determining the presence of tumor in biopsies and the decision-making during resections is often dependent on intraoperative rapid frozen-section histopathology. Recently, stimulated Raman scattering microscopy has been introduced to rapidly generate digital hematoxylin-and-eosin-stained-like images (stimulated Raman histology) for intraoperative analysis. To enable intraoperative prediction of tumor presence, we aimed to develop a new deep residual convolutional neural network in an automated pipeline and tested its validity. In a monocentric prospective clinical study with 94 patients undergoing biopsy, brain or spinal tumor resection, Stimulated Raman histology images of intraoperative tissue samples were obtained using a fiber-laser-based stimulated Raman scattering microscope. A residual network was established and trained in ResNetV50 to predict three classes for each image: (1) tumor, (2) non-tumor, and (3) low-quality. The residual network was validated on images obtained in three small random areas within the tissue samples and were blindly independently reviewed by a neuropathologist as ground truth. 402 images derived from 132 tissue samples were analyzed representing the entire spectrum of neurooncological surgery. The automated workflow took in a mean of 240 s per case, and the residual network correctly classified tumor (305/326), non-tumorous tissue (49/67), and low-quality (6/9) images with an inter-rater agreement of 89.6% (κ = 0.671). An excellent internal consistency was found among the random areas with 90.2% (Cα = 0.942) accuracy. In conclusion, the novel stimulated Raman histology-based residual network can reliably detect the microscopic presence of tumor and differentiate from non-tumorous brain tissue in resection and biopsy samples within 4 min and may pave a promising way for an alternative rapid intraoperative histopathological decision-making tool.

Variation in Glycemic Outcomes in Focal Forms of Congenital Hyperinsulinism-The UK Perspective.

ContextIn focal congenital hyperinsulinism (CHI), localized clonal expansion of pancreatic β-cells causes excess insulin secretion and severe hypoglycemia. Surgery is curative, but not all lesions are amenable to surgery.ObjectiveWe describe surgical and nonsurgical outcomes of focal CHI in a national cohort.MethodsPatients with focal CHI were retrospectively reviewed at 2 specialist centers, 2003-2018.ResultsOf 59 patients with focal CHI, 57 had heterozygous mutations in ABCC8/KCNJ11 (51 paternally inherited, 6 de novo). Fluorine-18 L-3,4 dihydroxyphenylalanine positron emission tomography computed tomography scan identified focal lesions in 51 patients. In 5 patients, imaging was inconclusive; the diagnosis was established by frozen section histopathology in 3 patients, a lesion was not identified in 1 patient, and 1 declined surgery. Most patients (n = 56) were unresponsive to diazoxide, of whom 33 were unresponsive or partially responsive to somatostatin receptor analog (SSRA) therapy. Fifty-five patients underwent surgery: 40 had immediate resolution of CHI, 10 had persistent hypoglycemia and a focus was not identified on biopsy in 5. In the 10 patients with persistent hypoglycemia, 7 underwent further surgery with resolution in 4 and ongoing hypoglycemia requiring SSRA in 3. Nine (15% of cohort) patients (1 complex surgical access; 4 biopsy negative; 4 declined surgery) were managed conservatively; medication was discontinued in 8 children at a median (range) age 2.4 (1.5-7.7) years and 1 remains on SSRA at 16 years with improved fasting tolerance and reduction in SSRA dose.ConclusionDespite a unifying genetic basis of disease, we report inherent heterogeneity in focal CHI patients impacting outcomes of both surgical and medical management.

Online learning tool for the acquisition of frozen-section histopathology knowledge

Online learning tool for the acquisition of frozen-section histopathology knowledge

A Case of Severe Adenomyosis in a Young Adolescent

Adenomyosis refers to a disorder in which endometrial glands are present within the uterine muscle which can be either diffuse or localized that may cause heavy menstrual bleeding, dysmenorrhea, and infertility. The disease usually affects multiparous women. Around 70-80% of the cases are reported in women of age between 40 and 50 years. Very few cases of adenomyosis in young adolescent are reported, and the diagnosis in such case becomes notoriously difficult, but still can be highly suspected with the help of ultrasound (USS) and Magnetic Resonance Imaging (MRI). Here, we present a case of 15-year old girl attending the emergency care with acute abdominal pain. The patient underwent diagnostic laparoscopy which revealed bleeding in the peritoneal cavity and a big hypertrophied uterus. Erosion and active bleeding was observed from the surface of the uterus; the case was advanced to laparotomy. The uterus was uniformly enlarged and boggy that was completely eroded and bled actively. Multiple biopsies were taken from different parts of uterine lesion and sent for frozen section histopathology examination. The blood was sucked from the peritoneal cavity, followed by placement of multiple hemostatic stitches. The results revealed severe adenomyosis. Only very few cases of adenomyosis in adolescents are reported to date and since fertility preservation is considered as an important goal, the traditional treatment of endometriosis may not be applicable to treat adenomyosis in case of young adolescent for fear of jeopardizing the reproductive life. Preserving the fertility in the adolescent and young adult patients poses a major challenge keeping in mind the adequate treatment required without affecting the general health of the patient.

Intraoperative frozen section histopathology for the diagnosis of periprosthetic joint infection in hip revision surgery: the influence of recent dislocation and/or periprosthetic fracture.

To evaluate the accuracy of intraoperative frozen section histopathology for diagnosing periprosthetic joint infection (PJI) during hip revision surgery, both for patients with and without recent trauma to the hip. The study included all revision total hip replacement procedures where intraoperative frozen section histopathology had been used for the evaluation of infection in a single institution between 2008 and 2015. Musculoskeletal Infection Society criteria were used to define infection. 210 hips were included for evaluation. Prior to revision surgery, 36 hips had a dislocation or a periprosthetic fracture (group A), and 174 did not (group B). The prevalence of infection was 14.3% (5.6% in group A and 16.1% in group B). Using Feldman criteria, the sensitivity of histopathology was 50.0%, specificity 47.1%, positive predictive value 5.3% and negative predictive value 94.1% in group A. The sensitivity of frozen section histopathology was 75.0%, specificity 96.5%, positive predictive value 85% and negative predictive value 95.3% in group B. Intraoperative frozen section histopathology is reliable for the diagnosis of PJI if no dislocation or periprosthetic fracture has occurred prior to hip revision surgery.

The Role of Fine Needle Aspiration Cytology and Frozen Section Histopathology in the Management of Parotid Gland Tumours: A 5- Year Experience in a UK Teaching Hospital

The Role of Fine Needle Aspiration Cytology and Frozen Section Histopathology in the Management of Parotid Gland Tumours: A 5- Year Experience in a UK Teaching Hospital

Real time FTIR spectroscopy of tissue smears from gynecologic cancer tissues: A preliminary study.

e17089 Background: Women with suspected Gynecologic cancer undergo surgical procedures during which tissue from suspected areas is excised. Fast histopathology analysis is performed intra-operatively using frozen section (FS) analysis, results of which are available within less than an hour. However, the accuracy of the FS test ranges between 75% and 100% when compared to final histopathology diagnoses. Fourier transform Infrared (FTIR) spectroscopy, utilized for classification of tissue samples into malignant and benign tumors, has shown comparable results to those of FS histopathology analysis. However, the sample preparation time and the effects of tissue preparation on the measured spectra have been a concern for the utilization of this technique in clinical practice. In this study we used attenuated total reflection (ATR) FTIR spectroscopy to examine fresh tissue impression smears as an alternative to the FS technique for rapid classification of tissue samples obtained during surgery. Methods: The study was approved by relevant ethics committees and was conducted in accordance with the Declaration of Helsinki. All patients provided written, informed consent. In total, 23 biopsies (ovarian and uterine) were extracted from suspected tumor sites during surgical procedures and sent to the histopathology laboratory for both pathological and FTIR analyses. Results of the histopathology analysis classified 15 samples as benign and 8 samples as malignant. Prior to the histopathologic analysis, tissue samples from these tumors were lightly pressed against the surface of an ATR crystal, leaving on its' surface impression smears. These smears were air dried for ~5 minutes. Mid-IR absorbance spectra were collected using an ATR-FTIR spectrometer. Machine learning techniques (PCA-LDA and SVM) were utilized to build discrimination models from the absorbance data of the measured smears. Sensitivity and specificity were calculated. Results: IR absorbance spectra of malignant smears were consistently higher from spectra of benign smears in the 850cm-1 to 1450 cm-1 range and they were consistently lower in the 3200cm-1 to 3600cm-1 range. The PCA-LDA discrimination model correctly classified the samples with a sensitivity and specificity of 100%, and the SVM showed a training accuracy of 100% and a cross validation accuracy of 91.3%. Conclusions: These preliminary results suggest that ATR-FTIR spectroscopy of tissue smears may have an important role in the development of next-generation techniques for intra-operative tumor classification.

Ambient ionization mass spectrometry imaging for disease diagnosis: Excitements and challenges

Tissue analysis in histology is extremely important and also considered to be a gold standard to diagnose and prognosticate several diseases including cancer. Intraoperative evaluation of surgical margin of tumor also relies on frozen section histopathology, which is time consuming, challenging and often subjective. Recent development in the ambient ionization mass spectrometry imaging (MSI) technique has enabled us to simultaneously visualize hundreds to thousands of molecules (ion images) in the biopsy specimen, which are strikingly different and more powerful than the single optical tissue image analysis in conventional histopathology. This paper will highlight the emergence of the desorption electrospray ionization MSI (DESI-MSI) technique, which is label-free, requires minimal or no sample preparation and operates under ambient conditions. DESI-MSI can record ion images of lipid/metabolite distributions on biopsy specimens, providing a wealth of diagnostic information based on differential distributions of these molecular species in healthy and unhealthy tissues. Remarkable success of this technology in rapidly evaluating the cancer margin intraoperatively with very high accuracy also promises to bring this imaging technique from bench to bedside.

Lymph Node Metastases Papillary Thyroid Carcinoma and their Importance in Recurrence of Disease

BackgroundThe purpose of this study is to establish whether the lymph node metastases of the papillary thyroid carcinoma are a significant factor in recurrence of the disease by analyzing the time until recurrence of the disease and frequency of recurrence of the disease.MethodsFrom 1 January 1995 until 30 June 2017, 102 patients were treated at the Public Health Institute Hospital “Sveti Vracevi” in Bijeljina for PTC. In all patients, surgery of the thyroid gland and/or lymph nodes of the neck was performed. Total thyroidectomy (TT) was performed in 20 patients and near-total thyroidectomy leaving <1 g thyroid tissue adjacent to the recurrent laryngeal nerve in 7 patients. TT and lymph nodes dissection were performed in 71 patients. Palliative surgery and biopsy due to locally advanced disease were performed in 3 patients.ResultsIn our study, 102 patients with PTC were analyzed. 82 patients experienced pure PTC (80.4%), the other 20 patients (19.6%) experienced other variants of PTC. 24 patients (23.5%) experienced multi centric or bilateral tumors. 71 patients (69.6%) experienced histologically verified metastases in the lymph nodes of the neck. 7 patients (6.8%) experienced distant metastases. 20 patients underwent total thyroidectomy (TT), and 7 near-total thyroidectomy. Total thyroidectomy + dissection of central and lower jugular lymph nodes with frozen section histopathology verification was performed in 71 patients (69.6%). Out of these 71 patients, in 50 patients (70.4%) metastases were verified in the lower jugular lymph nodes. A modified lymph node dissection (MRND) was also performed in these patients.ConclusionLymph node metastases of the papillary thyroid carcinoma are a plausible prognostic factor. They are important for recurrence of the disease, but not for survival.

Anticipatory extended cholecystectomy: the 'Lucknow' approach for thick walled gall bladder with low suspicion of cancer.

Gall stones (GS) cause inflammation of the gall bladder (GB) i.e., chronic cholecystitis (CC) and xantho-granulomatous cholecystitis (XGC) which can result in a thick walled GB (TWGB). Gall bladder cancer (GBC) may also present as TWGB. While CC and XGC can be treated with simple cholecystectomy (SC), GBC merits extended cholecystectomy (EC). We propose a new surgical approach, anticipatory extended cholecystectomy (AEC), for doubtful TWGB in the belief that AEC would not violate the sacrosanct cholecysto-hepatic plane in doubtful cases and thereby not ruin the chances of cure for a patient whose GB demonstrates malignancy on frozen section histopathology. The addition of lymphadenectomy in cases which turn out to be malignant completes the procedure for GB cancer, but spares all problems related to lymphadenectomy in an undeserving patient. AEC involves removal of GB with a 2-cm wedge of liver, which is then subjected to frozen section histological examination. Lymphadenectomy is performed if GBC is confirmed. AEC was performed in 13 patients between January 2011 and June 2014. During the same period, 1,673 SC for CC/XGC and 116 EC for GBC were performed. All patients were symptomatic for GS (3 with acute cholecystitis). Ultrasonography (US) raised suspicion of GBC in 11 patients. CT raised suspicion of GBC in 9 patients. Preoperative FNAC was done in 2 patients; in 1 it was negative and in 1 it was suspicious for malignancy. Preoperative diagnosis was GBC in 8, TWGB in 2, XGC, porcelain GB and GB perforation in 1 each. AEC and frozen section was done in all 13 patients. It was reported as GBC in 2 patients and as suspicious of GBC in 1 patient; lymphadenectomy was performed in these 3 patients. Final histopathology revealed XGC in 9, CC in 2 and GBC in 2 patients. In patients with TWGB on US/ CT with low suspicion of cancer, AEC serves as a triage-if frozen section biopsy turns out to be positive for GBC, AEC can be completed to EC by performing lymphadenectomy. We wish to name this approach as the 'Lucknow' approach for TWGB.

Response to letter to the editors "Re: Byung-Do Lee, Wan Lee, Kyung-Hwan Kwon, Moon-Ki Choi, Eun-Joo Choi and Jung-Hoon Yoon. Glandular odontogenic cyst mimicking ameloblastoma in a 78-year-old female: a case report. Imaging Science in Dentistry 2014; 44(3): 249-52.".

Response to letter to the editors "Re: Byung-Do Lee, Wan Lee, Kyung-Hwan Kwon, Moon-Ki Choi, Eun-Joo Choi and Jung-Hoon Yoon. Glandular odontogenic cyst mimicking ameloblastoma in a 78-year-old female: a case report. Imaging Science in Dentistry 2014; 44(3): 249-52.".

High Resolution Magic Angle Proton Magnetic Resonance Spectroscopy (HRMAS) in Intact Sentinel Node Biopsy from Breast Cancer Patients: A New Diagnostic Tool!

Introduction: The extent of axillary lymph node involvement is one of the most important prognostic markers in patients of breast cancer. However, axillary dissection is associated with significant morbidity. The intra-operative sentinel node biopsy (SNB) provides a basis for omitting the routine axillary clearance however; use of in-house frozen section histopathology is required in order to substitute later. We report the use of in vitro high resolution magic angle proton magnetic resonance spectroscopy (HRMAS) for assessing the axillary nodal status with increased sensitivity. Methods: Freshly removed axillary lymph nodes (n=17) obtained during sentinel node biopsy from 17 different patients were bisected. One segment of the bisected node was snap frozen and transported to HRMAS laboratory and was blindly subjected to 400 MHz high resolution magic angle proton magnetic resonance spectroscopy. The other portion was sent for frozen section biopsy. The tissues specimens used for HRMAS analysis and remaining portion of bisected node were then formalin fixed, paraffin embedded and sent for histo-pathological examination in separate vials. The metabolic profiles of these nodes were correlated with the routine histo-pathogical findings. Results: On histo-pathological examination, 7 nodes were found to be positive for metastasis were as 10 nodes were negative. The spectra of nodes (n=7) found to be positive for malignant cells were exclusively dominated by signals from choline, choline containing compounds and lactate in the spectral region of 3.2 ppm and 4.12 ppm respectively. Overall the sensitivity and specificity of HRMAS in the present study was 100%. Conclusion: Metastatic and non-involved lymph nodes in breast cancer can be accurately distinguished based on its metabolic profile. The technique of high resolution magic angle proton magnetic resonance spectroscopy can be utilized in enhancing the sensitivity and specificity of sentinel node biopsy and may replace frozen section histopathology

Optimization of multimodal spectral imaging for assessment of resection margins during Mohs micrographic surgery for basal cell carcinoma.

Multimodal spectral imaging (MSI) based on auto-fluorescence imaging and Raman micro-spectroscopy was used to detect basal cell carcinoma (BCC) in tissue specimens excised during Mohs micrographic surgery. In this study, the MSI algorithm was optimized to maximize the diagnosis accuracy while minimizing the number of Raman spectra: the segmentation of the auto-fluorescence images was optimized according to the type of BCC, sampling points for Raman spectroscopy were generated based on auto-fluorescence intensity variance and segment area, additional Raman spectra were acquired when performance of the segmentation algorithm was sub-optimal. The results indicate that accurate diagnosis can be achieved with a sampling density of ~2,000 Raman spectra/cm(2), based on sampling points generated by the MSI algorithms. The key benefit of MSI is that diagnosis of BCC is obtained based on intrinsic chemical contrast of the tissue, within time scales similar to frozen-section histopathology, but without requiring laborious sample preparation and subjective interpretation of stained frozen-sections.

Increasing the speed of tumour diagnosis during surgery with selective scanning Raman microscopy

One of the main challenges in cancer surgery is ensuring that all tumour cells are removed during surgery, while sparing as much healthy tissue as possible. Histopathology, the gold-standard technique for cancer diagnosis, is often impractical for intra-operative use because of the time-consuming tissue preparation procedures (sectioning and staining). Raman micro-spectroscopy is a powerful technique that can discriminate between tumours and healthy tissues with high accuracy, based entirely on intrinsic chemical differences. However, raster-scanning Raman micro-spectroscopy is a slow imaging technique that typically requires data acquisition times as long as several days for typical tissue samples obtained during surgery (1×1cm2) – in particular when high signal-to-noise ratio spectra are required to ensure accurate diagnosis. In this paper we present two techniques based on selective sampling Raman micro-spectroscopy that can overcome these limitations. In selective sampling, information regarding the spatial features of the tissue, either measured by an alternative optical technique or estimated in real-time from the Raman spectra, can be used to drastically reduce the number of Raman spectra required for diagnosis. These sampling strategies allowed diagnosis of basal cell carcinoma in skin tissue samples excised during Mohs micrographic surgery faster than frozen section histopathology, and two orders of magnitude faster than previous techniques based on raster-scanning Raman microscopy. Further development of these techniques may help during cancer surgery by providing a fast and objective way for surgeons to ensure the complete removal of tumour cells while sparing as much healthy tissue as possible.

Cystic spinal schwannomas: A short series of six cases. Can we predict them preoperatively?

Background:Spinal schwannomas are benign tumors arising from the spinal nerve root sheaths and are the commonest intradural extramedullary spinal tumors. Though cystic changes in schwannomas are well described, predominantly cystic schwannomas are uncommon lesions and form a different spectrum of conditions as compared with the commonly seen intradural extramedullary solid lesions.Case Description:We present a case series of six patients with spinal intradural extramedullary cystic schwannomas. Two patients had uniloculated cystic schwannomas, two patients had multi-loculated cystic lesions with thick walls and intralesional septations, and two patients had giant cystic schwannomas, one of which had an extradural extension. We report two cases in which preoperative radiological dilemma was encountered and discuss the differential diagnoses of this uncommon entity.Conclusion:Cystic spinal schwannomas may be confused with other cystic lesions in the spine, differentiating them preoperatively is important and in this regard, contrast-enhanced magnetic resonance imaging plays a vital role. Frozen section histopathology should be used to identify them at surgery. It is important to detect these lesions at surgery, as total excision is possible and almost always results in good long-term neurological outcome.

Eyelid Margin Basal Cell Carcinoma Managed With Full-Thickness En-Face Frozen Section Histopathology

To determine the tumor control rate of basal cell carcinoma (BCC) of the eyelid margin managed by full-thickness eyelid resection with en-face frozen section-controlled margins and primary reconstruction of the defect. This is a retrospective, consecutive, noncomparative, longitudinal interventional case series from a single institution. A review of medical records of all patients with BCC involving the eyelid margin treated by full-thickness en-face frozen section histopathology between June 1997 and June 2011 was conducted. All cases were managed with gross full-thickness resection of the eyelid margin tumor with subsequent reconstruction. Intraoperative frozen section histopathology was performed on additional 1-mm thick medial, lateral, and inferior/superior specimens in a full-thickness en-face fashion. The main outcome measure was rate of recurrence over the follow-up period. Additional data collected included patient demographics, lesion site and size, histopathology, reconstructive technique, and postoperative complications. The review resulted in a total of 74 patients with 77 lesions. Of these, 45 lesions had a minimum 5-year follow up. Those cases that involved the lacrimal system were excluded resulting in a total of 43 cases for analysis, which had a mean follow up of 6.4 years (range, 5.0-13.0). Three cases (6.9%) represented a recurrent BCC, while all other cases were primary BCCs. The histopathological subtypes included nodular (65.1%), infiltrative (18.6%), and superficial (16.3%). There were no cases of recurrence (100% cure rate) over the follow-up period. Most defects (88.4%) were reconstructed by direct closure or a temporal rotation flap. The only complication noted was the development of a hypertrophic scar in 1 patient that resolved with conservative management. In the total series of 77 lesions, the mean follow-up period was 4.5 years (range, 0.5-13.0). One recurrence (1.3%) was detected after 1.1 years for an infiltrative BCC measuring 10.0 mm in diameter that involved the lacrimal system. Eyelid margin BCC can be managed effectively with full-thickness en-face frozen section-controlled excision and primary reconstruction of the defect. The high cure rate compares favorably with other excision techniques such as Mohs micrographic surgery, with the advantages of a single operation and excellent reconstructive result.

The Sensitivity and Specificity of Frozen-Section Histopathology in the Management of Benign Oral and Maxillofacial Lesions

The management of odontogenic cysts and tumors typically requires a biopsy, which may present significant challenges and prompt an additional visit to the operating room before definitive treatment. The aim of this study was to determine the validity of frozen-section diagnosis in the management of benign oral and maxillofacial lesions, allowing intraoperative diagnosis followed by definitive treatment under the same general anesthetic. A retrospective chart review of patients treated at the University of Michigan Health System was performed. Patients of all ages who had a diagnosis of a benign maxillofacial lesion by frozen-section and permanent histopathology reports were included for analysis. Patients were identified using the Current Procedural Terminology code for enucleation and curettage and International Classification of Diseases, Ninth Revision codes for benign cysts or tumors of skull, face, or lower jaw. Of 450 patients reviewed, 214 had intraoperative frozen-section examination available for comparison with permanent histopathology. There were 121 men (56.5%) and 93 women (43.5%), with amean age of 41years. Compared with final permanent histopathology, the overall sensitivity of frozen sections was 92.1%. Frozen-section histopathology had a sensitivity greater than 90% and a specificity greater than 95% for the diagnosis of dentigerous cyst and keratocyst odontogenic tumor. In this study of 214 patients with benign maxillofacial lesions, frozen-section histopathology was found to be a valid diagnostic modality with high sensitivity, specificity, and positive and negative predictive values. These results and analysis support the use of frozen-section histopathology for the treatment of benign maxillofacial lesions and underscore its value in the management of these lesions.

The Sensitivity and Specificity of Frozen-Section Histopathology in the Management of Benign Oral and Maxillofacial Lesions

The management of odontogenic cysts and tumors involve treatment based on known biological behavior of the lesion and the recurrence rate. This typically requires an office biopsy which may present significant challenges when dealing with deep-seated lesions, pediatric patients, the medically compromised, or severely anxious patients, prompting an additional visit to the operating room for biopsy. These patients are thus exposed to morbidities including associated delay in definitive treatment, anesthesia, added cost, time away from work or school, and post-operative discomfort. A possible solution to the above scenario is the use of frozen sections. This would allow intra-operative diagnosis followed by definitive treatment under the same general anesthetic in many cases. The aim of this study is to determine the validity of frozen-section diagnosis in the management of benign oral and maxillofacial lesions.