Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: A meta-analysis

James A Higginson; Omar Breik; Alexandra H Thompson; Hutan Ashrafian; John C Hardman; Zoltan Takats; Vinidh Paleri; Jagtar Dhanda

doi:10.1016/j.oraloncology.2023.106419

Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: A meta-analysis

Oral Oncol. 2023 Jul:142:106419. doi: 10.1016/j.oraloncology.2023.106419. Epub 2023 May 12.

Authors

James A Higginson¹, Omar Breik², Alexandra H Thompson³, Hutan Ashrafian⁴, John C Hardman⁵, Zoltan Takats⁴, Vinidh Paleri⁶, Jagtar Dhanda⁷

Affiliations

¹ Faculty of Medicine, Imperial College London, UK. Electronic address: j.higginson19@imperial.ac.uk.
² School of Dentristy, University of Queensland, Australia.
³ Department of Oral and Maxillofacial Surgery, Royal Derby Hospital, UK.
⁴ Faculty of Medicine, Imperial College London, UK.
⁵ International Centre for Recurrent Head and Neck Cancer, The Royal Marsden NHS Foundation Trust, UK.
⁶ International Centre for Recurrent Head and Neck Cancer, The Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK.
⁷ Department of Surgery, Brighton and Sussex Medical School, UK.

PMID: 37178655
DOI: 10.1016/j.oraloncology.2023.106419

Abstract

Background: Positive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged.

Methods: The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model.

Results: From an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833.

Conclusions: Frozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results.

Keywords: Diagnostic accuracy; Frozen section; Head and neck squamous cell carcinoma; Meta-analysis; Optical spectroscopy; Rapid evaporative ionization mass spectrometry; Surgical margins; Touch imprint cytology; Tumour-targeted fluorescence.

Publication types

Meta-Analysis
Review
Research Support, Non-U.S. Gov't

MeSH terms

Frozen Sections*
Head and Neck Neoplasms* / diagnosis
Head and Neck Neoplasms* / surgery
Humans
ROC Curve
Sensitivity and Specificity
Squamous Cell Carcinoma of Head and Neck / diagnosis
Squamous Cell Carcinoma of Head and Neck / surgery

Grants and funding

NIHR 300975/DH_/Department of Health/United Kingdom