Utility of frozen section pathology in oral squamous cell carcinoma: a systematic review and meta-analysis

The impact of intraoperative frozen section analysis on final margin status, loco-regional recurrence, and survival in patients with oral squamous cell carcinoma (OSCC) remains uncertain. This systematic review and meta-analysis was performed to compare outcomes of OSCC resections performed with intraoperative frozen section analysis versus gross clinical examination alone. Primary outcomes included final margin status, recurrence, and survival. The literature search was performed on August 18, 2024 via PubMed, Embase, Scopus, and Cochrane Library. R statistical software was used for the data synthesis, and the quality of evidence was evaluated with the GRADE framework. Five studies met the inclusion criteria. Meta-analysis showed no significant difference in the pooled estimates for clear margins (relative risk (RR) 1.01, 95% confidence interval (CI) 0.97-1.06), positive margins (RR 0.84, 95% CI 0.26-2.73), or close margins (RR 0.86, 95% CI 0.61-1.20) between the frozen section and clinical examination cohorts. A narrative synthesis for recurrence and survival outcomes also demonstrated no significant differences. GRADE assessment indicated a low level of evidence quality and certainty of results. Current evidence does not support a clear advantage of intraoperative frozen section analysis over gross examination alone for improving margin status, recurrence, or survival in OSCC. Further prospective, high-quality, and possibly randomized studies are needed to establish the definitive role of frozen section in improving patient outcomes.