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Dissecting discrepancies in head and neck margin assessment: frozen versus permanent sections
Jake A Langlie1, Gabriella F Rodriguez1, Dayra Gutierrez Alonso2
1Department of Pathology, University of Miami Hospital and Clinics/Sylvester Comprehensive Cancer Center, Miami, FL, United States.
Objectives:
Concordance between intraoperative frozen section (FS) and subsequent corresponding permanent section (PS) diagnoses is essential for quality patient care. Reported FS-PS discrepancy rates for head and neck (HN) cases average 3% to 4%, mostly due to inadequate sampling and interpretation errors. We sought to review our experience with FS and concordant PS from HN pathology cases diagnosed at a high-volume university medical center.
Methods:
A concordance review was performed for intraoperative FS and corresponding PS of HN surgical pathology cases over a 3-year period. A focused analysis was performed on FS-PS discordances related to margin status (MS) control. The FS-PS discrepancies were classified as due to "sampling" or "interpretation."
Results:
In total, 2337 HN cases yielded 11 108 intraoperative FS diagnoses. The FS-PS concordance review identified 143 (1.29%) discrepancies. Of these, 82 (57.4%) were for MS control, with just over half due to "sampling." The FS slides generally represented a single top section taken from the tissue, with "sampling" discrepancies due to discordant diagnoses identified on a deeper cut of tissue on the PS slides. Common "interpretation" discrepancies included overlooking high-grade squamous dysplasia (HGD) present on the FS.
Conclusions:
Our institutional intraoperative FS-PS discrepancy rate for HN pathology cases is 1.29% and well within the national quality standards. Our FS-PS discrepancy rate for HN cases related to MS control was mostly due to "sampling." Interpretation discordances included failure to report HGD on the FS slide. Based on our review, the FS-PS discrepancies for MS control did not have a major clinical impact on most patients.
Insights
Head and neck pathology frozen section diagnoses show a low discrepancy rate of 1.29% compared to permanent sections. Most frozen section-permanent section discrepancies were due to sampling errors, particularly for margin status control, with minimal clinical impact.
Area of Science:
- Pathology
- Surgical Pathology
- Head and Neck Oncology
Background:
- Intraoperative frozen section (FS) and permanent section (PS) concordance is crucial for patient care.
- Head and neck (HN) FS-PS discrepancy rates average 3-4%, often due to sampling or interpretation errors.
Purpose of the Study:
- To review the institutional experience with FS and PS concordance in HN pathology cases.
- To analyze FS-PS discrepancies, focusing on margin status (MS) control and causes (sampling vs. interpretation).
Main Methods:
- Concordance review of intraoperative FS and corresponding PS for HN surgical pathology cases over 3 years.
- Classification of FS-PS discrepancies as 'sampling' or 'interpretation' errors.
Main Results:
- A total of 2337 HN cases yielded 11,108 FS diagnoses.
- The FS-PS concordance rate was 98.71%, with 143 (1.29%) discrepancies.
- Margin status control accounted for 57.4% of discrepancies, primarily due to sampling errors.
Conclusions:
- The institutional FS-PS discrepancy rate of 1.29% for HN pathology meets national quality standards.
- Sampling errors were the main cause of MS control discrepancies.
- Interpretation errors included overlooking high-grade squamous dysplasia (HGD); most discrepancies had no major clinical impact.
