Intraoperative Depth of Invasion is Accurate in Early Stage Oral Cavity Squamous Cell Carcinoma

Publication date: Available online 20 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Justine Moe, Jonathan B. Mchugh, Aaron M. Udager, Thomas M. Braun, Joseph I. Helman, Brent B. Ward

ABSTRACT

Background

Depth of invasion (DOI) is one predictor of nodal metastasis in oral cavity squamous cell carcinoma (OCSCC) and can facilitate the decision to complete an elective neck dissection (END) in early stage disease with a clinically negative neck. The purpose of this study was to investigate the accuracy of DOI on intraoperative frozen specimen for T1N0 oral OCSCC.

Methods

A prospective, blinded study of 30 patients with cT1N0 OCSCC was completed between October 2016 and December 2017 comparing the accuracy of DOI on frozen versus permanent specimen.

Results

DOI on frozen specimen was 96.8% accurate in predicting the need for END with a sensitivity of 90.9%, specificity of 100%, positive predictive value of 100% and negative predictive value of 95.2%. There was a strong correlation between DOI on frozen and permanent specimens measured by head-and-neck (HN) pathologists (r=0.96, 95% CI 0.93 – 0.97), between HN pathologists on frozen specimen (r=0.98, 95% CI 0.95 – 0.99) and permanent specimen (r=0.95, 95% CI 0.91 – 0.98), and between DOI on frozen specimen communicated intraoperatively versus measured by HN pathologist 1 (r=0.93, 95% CI 0.86 – 0.97) and 2 (r=0.95, 95% CI 0.89 – 0.98). Only one patient who did not undergo a END based on frozen specimen was undertreated due to up-grading of DOI on permanent specimen.

Conclusion

DOI on intraoperative frozen section has an accuracy of 96.8% and may be reliably used as a clinical tool to determine the need for END in early stage OCSCC.

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