Gross examination by the surgeon as an alternative to frozen section for assessment of adequacy of surgical margin in head and neck squamous cell carcinoma

Abstract

Background: The cost-effectiveness of the frozen section for assessment of margin in head and neck squamous cell carcinoma (HNSCC) is still contentious. The purpose of this study was to evaluate whether gross examination of margin is an alternative to frozen section.

Methods: It was a prospective observational study in 145 consecutive patients undergoing surgery for HNSCC. Surgical margins were first assessed by the surgeons with a metallic scale. All specimens were then examined using frozen section and permanent section.

Results: Overall, 83% of inadequate margins were detected by frozen section. The chances of inadequate margin were very low if gross surgical margin were 7 mm or more. Gross examination alone (with 7 mm as cutoff) predicted 88% of the inadequate surgical margin. There was no difference in precision of frozen section vis-à-vis gross examination with 7 mm cut off (p ≤ .8).

Conclusion: Achievement of 7 mm surgical margin measured by a surgeon obviates the need for frozen section.

Keywords: frozen section; gross assessment; head and neck squamous cell carcinoma; surgical margin.