Abstract：
BACKGROUND: The adequacy of the cut end of the mandible following a segmental mandibulectomy done for oral cancer intraoperatively is at times assessed using a frozen section (FS) of the bone marrow (BM) at the cut ends. The study aimed to assess its utility to guide the intraoperative decision on the adequacy of bony margins.
METHODS: All patients with oral squamous cell carcinoma (OSCC) who underwent segmental mandibulectomy from January 2012 to December 2021 at our institute and for whom intraoperative FS of BM was utilized were included. We analyzed the sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of this in predicting positive bone margins.
RESULTS: A total of 457 patients were included in the study. The majority of the cases were per premium cases (n = 372, 81.4%). The median age of the cohort was 52 years (range: 22-80 years). Most patients had T4 disease (n = 406, 88.8%). On FS, BM was positive in only 18 patients (3.9%) for whom the bone margin was revised. BM biopsy report in the final histopathology was positive in 12 patients (2.2%). The sensitivity, specificity PPV, and NPV were 52.3%, 98.65%, 64.7%, and 97.7% respectively. No factors predicting BM positivity on FS could be identified in this cohort.
CONCLUSIONS: The BM FS was positive in only a small percentage of patients, and it helped in reducing the bone margin positivity rate from 3.9% to 2.2% only. Hence the intraoperative BM FS seems to have limited utility as seen from our study.
METHODS: All patients with oral squamous cell carcinoma (OSCC) who underwent segmental mandibulectomy from January 2012 to December 2021 at our institute and for whom intraoperative FS of BM was utilized were included. We analyzed the sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of this in predicting positive bone margins.
RESULTS: A total of 457 patients were included in the study. The majority of the cases were per premium cases (n = 372, 81.4%). The median age of the cohort was 52 years (range: 22-80 years). Most patients had T4 disease (n = 406, 88.8%). On FS, BM was positive in only 18 patients (3.9%) for whom the bone margin was revised. BM biopsy report in the final histopathology was positive in 12 patients (2.2%). The sensitivity, specificity PPV, and NPV were 52.3%, 98.65%, 64.7%, and 97.7% respectively. No factors predicting BM positivity on FS could be identified in this cohort.
CONCLUSIONS: The BM FS was positive in only a small percentage of patients, and it helped in reducing the bone margin positivity rate from 3.9% to 2.2% only. Hence the intraoperative BM FS seems to have limited utility as seen from our study.
摘要：
背景：术中对口腔癌进行节段性下颌骨切除术后，有时在切割端使用骨髓（BM）的冷冻切片（FS）评估下颌骨的切割端是否足够。该研究旨在评估其实用性，以指导术中决定骨缘的充分性。
方法：纳入2012年1月至2021年12月在我们研究所接受节段性下颌骨切除术的所有口腔鳞状细胞癌（OSCC）患者，并使用了BM的术中FS。我们分析了敏感性,特异性，以及阳性和阴性预测值(PPV，NPV）在预测骨缘阳性方面。
结果：共457例患者纳入研究。大多数病例为保费病例(n=372，81.4%)。该队列的中位年龄为52岁（范围：22-80岁）。大多数患者患有T4疾病（n=406，88.8％）。在FS上，只有18例（3.9％）的骨缘修正患者的BM为阳性。最终组织病理学中的BM活检报告在12例患者中呈阳性（2.2％）。敏感性,特异性PPV，净现值为52.3%，98.65%,64.7%,分别为97.7%。在该队列中没有发现预测FS上BM阳性的因素。
结论：仅一小部分患者的BMFS呈阳性，它有助于将骨缘阳性率从3.9%降低到2.2%。因此，从我们的研究中可以看出，术中BMFS的效用似乎有限。
方法：纳入2012年1月至2021年12月在我们研究所接受节段性下颌骨切除术的所有口腔鳞状细胞癌（OSCC）患者，并使用了BM的术中FS。我们分析了敏感性,特异性，以及阳性和阴性预测值(PPV，NPV）在预测骨缘阳性方面。
结果：共457例患者纳入研究。大多数病例为保费病例(n=372，81.4%)。该队列的中位年龄为52岁（范围：22-80岁）。大多数患者患有T4疾病（n=406，88.8％）。在FS上，只有18例（3.9％）的骨缘修正患者的BM为阳性。最终组织病理学中的BM活检报告在12例患者中呈阳性（2.2％）。敏感性,特异性PPV，净现值为52.3%，98.65%,64.7%,分别为97.7%。在该队列中没有发现预测FS上BM阳性的因素。
结论：仅一小部分患者的BMFS呈阳性，它有助于将骨缘阳性率从3.9%降低到2.2%。因此，从我们的研究中可以看出，术中BMFS的效用似乎有限。
