Perioperative frozen section examination in parotid gland tumors
Keywords:
Frozen section, Head and Neck tumors;, Parotid gland tumors, Salivary gland tumorsAbstract
CONTEXT: The minimal recommended surgical approach to parotid tumors is partial parotidectomy with resection of the superficial lobe of the gland. Histologic diagnosis prior to surgery is not possible, as incisional biopsies are contraindicated due to the possibility of facial nerve injury or incomplete tumor resection. Thus, the biopsies tend to be perioperative. OBJECTIVE: To compare the results of frozen section examination with the definitive pathological diagnosis. DESIGN: Accuracy study by retrospective analysis. SETTING: Head and Neck Surgery Service of Heliópolis Hospital, São Paulo, Brazil. SAMPLE: 153 cases of parotid gland tumors treated between 1977 and 1994. DIAGNOSTIC TEST: Frozen section and pathological diagnosis. MAIN MEASUREMENTS: Sensibility and specificity of the frozen section examination. RESULTS: Frozen section study diagnosed 19 (12.4%) malignant and 127 (83.7%) benign tumors. Sensitivity of the frozen sections for malignancy was 61.5% (95% CI 54 to 69%) and specificity was 98% (95% CI 94 to 100%), and this result is comparable to the literature. CONCLUSIONS: We consider that frozen section examination for salivary gland tumors is not sufficient on its own for deciding on the best management. Their interpretation must be correlated with clinical and intraoperative findings, in association with the surgeon's experience.
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References
Pitts HH, Sturdy JH, Coady CJ. Frozen sections II: value in cases of suspected malignancy. Can Med Assoc 1958;79:110-3.
Nakazawa H, Rosen P, Lane N, Lattes R. Frozen section experience in 3000 cases: accuracy, limitations and value in residency training. Am J Clin Pathol 1968;49:41-51.
Didzans LJ, VanNostrand AWP. The accuracy of frozen section diagnosis of parotid lesions. J Otolaryngol 1984;13:382-6.
Rapoport A, Carvalho MB, Fava AS, Magrin J, Andrade Sobrinho J. Tumores mistos da glândula parótida: estudo de 100 casos. Rev Col Bras Cir 1979;6:103-6.
Carvalho MB, Rapoport A, Andrade Sobrinho J, et al. Estudo clínico e terapęutico do câncer de parótida. Rev Paul Med 1977;90:97-101.
Rapoport A, Andrade Sobrinho J, Carvalho MB, Magrin J, Fava AS. Cancer of the parotid gland. Int Surg 1981;66:243-6.
Rapoport A, Carvalho MB, Fava AS. Diagnóstico e tratamento das neoplasias das glândulas salivares menores: estudo de 55 casos. Rev Col Bras Cir 1988;15:289-93.
Heller KS, Attie JN, Dubner S. Accuracy of frozen section in the evaluation of salivary tumors. Am J Surg 1993;166:424-7.
Rapoport A, Fava AS, Kowalski LP. Tumor misto benigno de parótida: estudo de 66 casos. Rev Col Bras Cir 1985;12:46-52
Layfield LJ, Tan P, Glasgow BJ. Fine needle aspiration of salivary gland lesion: comparison with frozen section and histologic findings. Arch Pathol Lab Med 1987;111:346-53.
Saltzstein SL, Nahum AM. Frozen section diagnosis: accuracy and errors, uses and abuses. Laryngoscope 1973;83:1128-43.
Winship T, Rosvoll RV. Frozen sections: an evaluation of 180 cases. Surgery 1959; 45:462-6.
Cross DL, Gansler TS, Morris RC. Fine needle aspiration and frozen section of salivary gland lesions. South Med J 1990;83:283-6.
Hillel AD, Fee WE. Evaluation of frozen section in parotid gland surgery. Arch Otolaryngol 1983;109:230-2.
Rigual NR, Milley P, Loré JM, Kaufman S. Accuracy of frozen section diagnosis in salivary gland neoplasms. Head Neck Surg 1986;8:442-6.
Granick MS, Erickson R, Hanna DC. Accuracy of frozen section diagnosis in salivary gland lesions. Head Neck Surg 1985;7:465-7.
Wheelis RF, Yarington T. Tumors of the salivary glands: comparison of frozen section diagnosis with final pathologic diagnosis. Arch Otolaryngol 1984;110:76-7.
Chann MKM, McGuire LJ, King W, Li AKC, Lee JCK. Cytodiagnosis of 112 salivary gland lesions: correlations with histologic and frozen section diagnosis. Acta Cytol 1992;36:353-63.
Miller R, Calcaterra TC, Paglia DE. Accuracy of frozen section diagnosis of parotid lesions. Ann Otol 1979; 88:573-6.
Cohen MB, Ljung BE, Boles R. Salivary gland tumors: fine needle aspiration versus frozen section diagnosis. Arch Otolaryngol Head & Neck Surg 1986;112:867-9.
Hoffman H, Funk G, Endres D. Evaluation and surgical treatment of tumors of the salivary glands. In: Thawley SE, Panje WR, Batsakis JG, LIndberg RD, editors. Comprehensive management of head and neck tumors. Philadelphia: WB Saunders; 1999:1147-81.
Eisele DW, Kleinberg LR, O'Malley BB. Management of malignant salivary gland tumors. In: Harrison LB, Sessions RB, Hong WK, editors. Head and neck cancer: a multidisciplinary approach. Philadelphia: Lippincott-Raven; 1999:721-48.
Megerian CA, Maniglia AJ. Parotidectomy: a 10-year experience with fine needle aspiration and frozen section biopsy correlation. ENT Journal 1994;73:377-80.
