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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.
American Journal of Clinical Pathology
|March 5, 2026
Summary
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.
