Frozen sections in head and neck surgery and the impact of intraoperative analysis on final resection margins: An institutional study




Head and Neck Pathology, Frozen Section Analysis, Resection Margins


Frozen section (FS) analysis is an indispensable tool for intraoperative patient management.To assess the utilisation of head and neck FS analysis, with a particular focus on the concordance rate between the intraoperative FS margin analysis and the final FFPE
results. Additionally, to determine whether FS analysis had any impact on intraoperative patient management.Lastly, to determine the impact of the FS analysis on the final margin status of resection specimens. Histopathology reports from January 2015 to December
2018 were reviewed at Pretoria Oral and Dental Hospital to analyse all FS requests involving the head and neck region. Captured data was analysed to determine the concordance rate, discordance rate, and FS deferral rates, with correlations performed using the Chi-square test. Eighty-two frozen section cases were reviewed with a total of 312 FS tissue sections performed. The majority
(73%) of the FS requests were from the Maxillofacial and Oral Surgery (MFOS) department for the assessment of surgical margins. The FS-FFPE concordance and discordance rates were at 97.5% and 2.4% respectively, with a deferral rate of 1.2%. Additional surgical margins were only received in 16 of the 26 cases with positive margins on intraoperative FS analysis. There was no statistically significant correlation between intraoperative FS positive margin status and advanced pathological T staging. The concordance rate between intraoperative FS margin analysis and final FFPE results were within an acceptable range. In a significant number of cases, the intraoperative FS margin analysis did not influence further surgical management.


Download data is not yet available.


Metrics Loading ...


Gal AA. The centennial anniversary of the frozen section technique at the Mayo Clinic. Arch Pathol Lab Med. 2005;129(12):1532-1535.

Sawady J, Berner JJ, Siegler EE. Accuracy of and reasons for frozen sections: a correlative, retrospective study. Hum Pathol. 1988;19(9):1019-1023.

Thomas Robbins K, Triantafyllou A, Suárez C, et al. Surgical margins in head and neck cancer: intra- and postoperative considerations. Auris Nasus Larynx. 2019;46(1):10-17.

Olson SM, Hussaini M, Lewis Jr JS. Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level. Original Article. Mod Pathol. 2011;24:665.

DiNardo LJ, Lin J, Karageorge LS, Powers CN. Accuracy, utility, and cost of frozen section margins in head and neck cancer surgery. The Laryngoscope. 2000;110(10):1773-1776.

Ord RA, Aisner S. Accuracy of frozen sections in assessing margins in oral cancer resection. J Oral Maxillofac Surg. 1997;55(7):663-669.

Mohiyuddin SMA, Padiyar BV, Suresh TN, et al. Clinicopathological study of surgical margins in squamous cell carcinoma of buccal mucosa. World Journal of Otorhinolaryngology-Head and Neck Surgery. 2016;2(1):17-21.

Mistry RC, Qureshi SS, Kumaran C. Post-resection mucosal margin shrinkage in oral cancer: Quantification and significance. J Surg Oncol. 2005;91(2):131-133.

Sams SB, Wisell JA. Discordance between intraoperative consultation by frozen section and final diagnosis: a classification model to guide quality improvement. Int J Surg Pathol. 2017;25(1):41-50.

Raab SS, Tworek JA, Souers R, Zarbo RJ. The Value of Monitoring Frozen Section–Permanent Section Correlation Data Over Time. Arch Pathol Lab Med. 2006;130(3):337-342.

Layfield EM, Schmidt RL, Esebua M, Layfield LJ. Frozen section evaluation of margin status in primary squamous cell carcinomas of the head and neck: a correlation study of frozen section and final diagnoses. journal article. Head Neck Pathol. 2018;12(2):175-180.

Du E, Ow TJ, Lo YT, et al. Refining the utility and role of frozen section in head and neck squamous cell carcinoma resection. The Laryngoscope. 2016;126(8):1768-1775.

Roy S, Parwani AV, Dhir R, Yousem SA, Kelly SM, Pantanowitz L. Frozen section diagnosis: is there discordance between what pathologists say and what surgeons hear? Am J Clin Pathol. 2013;140(3):363-369.

Taxy JB. Frozen section and the surgical pathologist: a point of view. Arch Pathol Lab Med. 2009;133(7):1135-1138.

McIntosh ER, Harada S, Drwiega J, Brandwein-Gensler MS, Gordetsky J. Frozen section: guiding the hands of surgeons? Ann Diagn Pathol. 2015;19(5):326-329.

Desciak EB, Maloney ME. Artifacts in frozen section preparation. Dermatol Surg. 2000;26(5):500-504.

Brandwein-Gensler M, Teixeira MS, Lewis CM, et al. Oral squamous cell carcinoma: histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival. The American journal of surgical pathology. 2005;29(2):167-178.

Upile T, Fisher C, Jerjes W, et al. The uncertainty of the surgical margin in the treatment of head and neck cancer. Oral Oncol. 2007;43(4):321-326.

Melancon CC, Clinger JD. The use of frozen section in the early diagnosis of acute invasive fungal sinusitis. Otolaryngology–Head and Neck Surgery. 2017;157(2):314-319.

Smith-Zagone MJ, Schwartz MR. Frozen section of skin specimens. Arch Pathol Lab Med. 2005;129(12):1536-1543.

Gandour-Edwards RF, Donald PJ, Wiese DA. Accuracy of intraoperative frozen section diagnosis in head and neck surgery: experience at a university medical center. Head Neck. 1993;15(1):33-38.

Meier JD, Oliver DA, Varvares MA. Surgical margin determination in head and neck oncology: current clinical practice. The results of an International American Head and Neck Society member survey. Head Neck. 2005;27(11):952-958.

Hinni ML, Ferlito A, Brandwein‐Gensler MS, et al. Surgical margins in head and neck cancer: a contemporary review. Head Neck. 2013;35(9):1362-1370.

van Lanschot CG, Mast H, Hardillo JA, et al. Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study. Head Neck. 2019:1-8.

Chen C-H, Hsu M-Y, Jiang R-S, Wu S-H, Chen F-J, Liu S-A. Shrinkage of head and neck cancer specimens after formalin fixation. J Chin Med Assoc. 2012;75(3):109-113.

Gerber S, Gengler C, Grätz KW, Kruse AL. The impact of frozen sections on final surgical margins in squamous cell carcinoma of the oral cavity and lips: a retrospective analysis over an 11 years period. Head Neck Oncol. 2011;3(1):56




How to Cite

Kungoane, T., Robinson, L. M. ., & Madiba, T. K. . (2022). Frozen sections in head and neck surgery and the impact of intraoperative analysis on final resection margins: An institutional study. South African Dental Journal, 77(01), 18–22.

Most read articles by the same author(s)