Utility of biopsy and frozen section in detecting malignancy within clinically suspicious verrucous growths: a...

Oral verrucous carcinoma (OVC) is a low-grade warty variant of oral squamous cell carcinoma. Although these verrucous lesions appear clinically malignant, biopsies often report them as benign, leading to repeat biopsies and diagnostic delay. A retrospective review of patients who underwent surgery for clinically suspicious oral verrucous growths between 2012 and 2022 was conducted. Overall, 228 patients were identified. Final histopathology confirmed OVC in 80 patients (35.1%). Biopsy showed very low sensitivity of 32.4% but high specificity of 93.5% for detecting malignancy in clinically suspicious verrucous growths. The positive predictive value (PPV), negative predictive value (NPV), and accuracy were 80.9%, 61.8%, and 65.3%. Frozen section similarly demonstrated low sensitivity of 39% with very high specificity of 98%. The PPV, NPV, and accuracy were 93.2%, 65.2%, and 70.6%. Univariate analysis identified tumour thickness (>5 mm vs ≤5 mm) (P < 0.001), pathological T stage (T3/T4 vs T1/T2) (P = 0.002), and neck dissection (modified vs selective) (P = 0.003) as significant prognostic factors in OVC. This study highlights the limitations of biopsy and frozen section in diagnosing OVC. Despite high specificity, their low sensitivity may result in misdiagnosis, emphasizing cautious interpretation and adjunctive diagnostic approaches to avoid treatment delay.