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 Table of Contents  
Year : 2021  |  Volume : 16  |  Issue : 3  |  Page : 430-432

Comparison between frozen section and paraffin-embedded histopathological section in oral squamous cell carcinoma

Department of Oral Pathology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India

Date of Submission11-Dec-2020
Date of Decision15-May-2021
Date of Acceptance18-Jun-2021
Date of Web Publication12-Mar-2022

Correspondence Address:
Dr. Madhuri Gawande
Department of Oral Pathology, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_440_20

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Background: Oral squamous cell carcinoma (SCC) is the major malignancy reported in Sharad Pawar Dental College and Hospital, Sawangi Meghe, Wardha, Maharashtra, India. The treatment of choice is radical neck dissection, while performing surgery frozen section (FS) analysis is done. FS helps in rapid intraoperative diagnosis. It is commonly used during surgical procedures to detect malignancy so that modifications of surgery can be decided at the time of surgery on the table. FS is also performed for the evaluation of surgical margins and detection of lymph node metastasis. In addition, it is applied for the detection of unknown pathological processes. Aims and Objectives: The objective of this study was to assess the accuracy of FS diagnosis in comparison to gold standard histopathological diagnosis and to find concordance and discordance rate of FS with histopathological report. Materials and Methods: We retrospectively reviewed records of frozen section from the department of Oral Pathology and Microbiology. The frozen section diagnosis was compared with permanent sections stained by haematoxylin and eosin stain. The frozen section results were compared with final histopathological diagnosis. Results: Sensitivity = 97.97%,Specificity = 100%, Percentage of false negative = 2%, Percentage of false positive = 0%. Conclusion: In our study frozen section diagnosis was coinciding with histopathological diagnosis.

Keywords: Oral squamous cell carcinoma, frozen section, histopathology

How to cite this article:
Gawande M, Hande A, Patil S, Sonone A, Sharma P. Comparison between frozen section and paraffin-embedded histopathological section in oral squamous cell carcinoma. J Datta Meghe Inst Med Sci Univ 2021;16:430-2

How to cite this URL:
Gawande M, Hande A, Patil S, Sonone A, Sharma P. Comparison between frozen section and paraffin-embedded histopathological section in oral squamous cell carcinoma. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2023 Jun 7];16:430-2. Available from: https://journals.lww.com/dmms/pages/default.aspx/text.asp?2021/16/3/430/339465

  Introduction Top

Frozen section (FS) evaluation has become a standard of practice for the intraoperative diagnosis of newly discovered lesions as well as confirmation of diagnosis in previously biopsied pathologic processes and to establish the extent of disease. The procedure has been shown to be sufficiently accurate for clinical utilization. FS concordance rates with permanent diagnosis average approximately 98%. The concordance rate varies somewhat by site, with the concordance rate for ovary being approximately 93% and somewhat lower at other sites such as the skin.[1]

The issue of margin adequacy is critical to the successful management of head-and-neck cancer patients. FS is commonly utilized for the determination of margin status for resection of head and neck primary carcinomas and further to prevent local recurrence. Many comparative studies regarding frozen and paraffin sections were extensively done to find out the reliability of FSs in the diagnosis of prostrate carcinoma, breast cancer, skin cancer, tumors of colon, gall bladder, and Kidney.[2] However, due to the paucity of specific studies in oral squamous cell carcinoma, this study was undertaken.

The present study gives information about the reliability of FS evaluation in oral squamous cell carcinoma (SSC). The microscopic features of FSs are compared with those of paraffin-embedded sections.

  Materials and Methods Top

We retrospectively reviewed the FS cases performed in Oral Pathology and Microbiology Department Sharadpawar Dental College and Hospital. We have examined

  • Superior margin
  • Inferior margin
  • Anterior margin
  • Medial margin
  • Distal margin
  • Level 1A
  • Level 1B
  • Level 11A
  • Level 11B
  • Level 111
  • Level IV
  • Submandibular gland
  • Submandibular LN
  • Tail of parotid
  • Superior skin
  • Resected specimen.

Tissue specimens sent for FS were frozen and cut by a cryostat machine.

The sections were fixed on glass slides and stained by Hematoxylin and Eosin (H and E). The remaining tissues were fixed in 10% formalin, processed, embedded in paraffin and stained with H and E.

Patient files in the pathology department provided data regarding the FS cases. The FS diagnoses were compared to that of the permanent sections, to assess the accuracy of the technique. The FS results in comparison to final diagnoses. With a proper FS study, diagnoses were considered as concordant if there was agreement and discordant if there was disagreement with permanent section diagnoses. Deferred cases were defined as indeterminate diagnoses at the time of FS examination. Deferral rate was not included in the calculation of accuracy. Finally, discordant cases were reviewed and causes of discrepancy were recorded.

  Results and Observations Top

Sensitivity = a/(a + c) ×100 = 97/(97 + 2) ×100 = 97.97%

Specificity = d/(b + d) ×100 = 1/(0 + 1) ×100 = 100%

Predictive value of a positive test = a/(a + b) ×100 = 97/(97 + 0) ×100 = 100%

Predictive value of a negative test = d/(c + d) ×100 = 1/(2 + 1) ×100 = 33.33%

Percentage of false negative = c/(a + c) ×100 = 2/(97 + 2) ×100 = 2%

Percentage of false positive = b/(b + d) ×100 = 0/(0 + 1) ×100 = 0% [Table 1].
Table 1: Frozen section result considering frozen section as gold standard

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  Discussion Top

In this study, we demonstrated the importance of the intraoperative FS for surgical margins of oral SCC as compared to the paraffin-embedded histopathological section. In our series of oral SCC cases which were surgically treated, additional surgery according to FS was shown to be effective at reducing recurrences from surgical margins. The present study has provided for the first time data to show that FS should be an integral part of any surgical intervention for oral SCC. In addition, it is now obvious from the present prognostic survey of surgical margins that our histopathological diagnostic criteria function in predicting local recurrences from surgical margins.

It has been emphasized that the control of metastasis is the ultimate, most important issue in cancer treatment. In the case of oral cancer, however, local recurrence is often a more basic and important issue to be solved because many of oral cancers arise in the background of Field cancerization.[3] For instance, superficial carcinoma, a lesional complex, consists of carcinoma in situ as a main focus, with scattered SCC foci in advanced forms, together with surrounding epithelial dysplasia. Hence, it is not always easy for a surgeon to determine precise surgical margins with the naked eye during surgery. As objective aids for setting surgical margins, Lugol's iodine or toluidine blue solutions have been utilized to visualize mucosal areas containing malignant lesions. However, the effectiveness of these vital staining methods remains inconclusive because their staining modes have not been well correlated to histopathological criteria of borderline malignancies.[4],[5] More recently, narrow-band imaging (NBI) has been introduced for the detection of extension areas of oral cancers, especially those containing superficial carcinoma, to determine surgical fields. The usefulness of NBI, which detects hemoglobin-derived blue rays, has been theoretically supported by our concept that intraepithelial blood vessels are characteristic to oral borderline malignancy lesions.[6],[7]

These surgical aids provide a reference only, whereas FS allows pathologists to evaluate surgical margins directly and histopathologically. There is no room for macroscopic determination of lesional extensions by individual surgeons, who must rely on past experience. As shown in the present study, oral SCC cases in which FS was performed showed significantly better prognoses.

When the FSs were compared with paraffin sections for accuracy in diagnosis, false positivity, false negativity, and disagreement were seen in other studies. The errors due to false positivity were ranged from 0.07% to 0.15%, false negativity were ranged from 0.7% to 10%, and the deferred diagnosis were 0.15% to 1.7%.[8],[9] However, in the present study, there were no errors, and thus, accurate FS diagnosis was observed.[8],[9],[10]

  Conclusion Top

In our study, FS results were coinciding with histopathological diagnosis so it is concluded that intraoperative FS has a significant role in the diagnosis of surgical margins in oral SCC and thus providing guidance to oral surgeon in radical neck dissection.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Prey MU, Vitale T, Martin SA. Guidelines for practical utilization of intraoperative frozen sections. Arch Surg 1989;124:331-5.  Back to cited text no. 1
Takahashi H, Yanamoto S, Yamada S, Umeda M, Shigeta T, Minamikawa T, et al. Effects of postoperative chemotherapy and radiotherapy on patients with squamous cell carcinoma of the oral cavity and multiple regional lymph node metastases. Int J Oral Maxillofac Surg 2014;43:680-5.  Back to cited text no. 2
Slaughter DP, Southwick HW, Smejkal W. Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin. Cancer 1953;6:963-8.  Back to cited text no. 3
Ohta K, Ogawa I, Ono S, Taki M, Mizuta K, Miyauchi M, et al. Histopathological evaluation including cytokeratin 13 and Ki-67 in the border between Lugol-stained and -unstained areas. Oncol Rep 2010;24:9-14.  Back to cited text no. 4
Zhang L, Williams M, Poh CF, Laronde D, Epstein JB, Durham S, et al. Toluidine blue staining identifies high-risk primary oral premalignant lesions with poor outcome. Cancer Res 2005;65:8017-21.  Back to cited text no. 5
Takano JH, Yakushiji T, Kamiyama I, Nomura T, Katakura A, Takano N, et al. Detecting early oral cancer: Narrowband imaging system observation of the oral mucosa microvasculature. Int J Oral Maxillofac Surg 2010;39:208-13.  Back to cited text no. 6
Funayama A, Maruyama S, Yamazaki M, Al-Eryani K, Shingaki S, Saito C, et al. Intraepithelially entrapped blood vessels in oral carcinoma in-situ. Virchows Arch 2012;460:473-80.  Back to cited text no. 7
Gephardt GN, Rice TW. Utility of frozen-section evaluation of lymph nodes in the staging of bronchogenic carcinoma at mediastinos - copy and thoracotomy. J Thorac Cardiovasc Surg 1990;100:853-9.  Back to cited text no. 8
Remacle M, Hamoir M, Marbaix E, Deggouj N, Frederickx Y. Interest in frozen section examination of margins and lymph nodes in laryngeal surgery. J Laryngol Otol 1988;102:818-21.  Back to cited text no. 9
Arora HL, Solanki RL, Gupta R. Evaluation of cryostat frozen section in the diagnosis of surgical biopsies. Indian J Pathol Microbiol 1991;34:136-9.  Back to cited text no. 10


  [Table 1]


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