The Sensitivity and Specificity of Frozen-Section Histopathology in the Management of Benign Oral and Maxillofacial Lesions
The management of odontogenic cysts and tumors involve treatment based on known biological behavior of the lesion and the recurrence rate. This typically requires an office biopsy which may present significant challenges when dealing with deep-seated lesions, pediatric patients, the medically compromised, or severely anxious patients, prompting an additional visit to the operating room for biopsy. These patients are thus exposed to morbidities including associated delay in definitive treatment, anesthesia, added cost, time away from work or school, and post-operative discomfort. A possible solution to the above scenario is the use of frozen sections. This would allow intra-operative diagnosis followed by definitive treatment under the same general anesthetic in many cases. The aim of this study is to determine the validity of frozen-section diagnosis in the management of benign oral and maxillofacial lesions.
Materials and methods:
A retrospective chart review of patients treated at the University of Michigan Health System, from 1999-2012, was performed. Patients with a diagnosis of benign maxillofacial lesion were included for analysis.
Method of data analysis:
Patients were identified by using CPT code for enucleation and curettage, and ICD-9 codes for benign cysts or tumors of skull and face, or lower jaw. The data was collected by electronic chart review of clinic visits, operative reports and pathology reports. This data was analyzed with Microsoft Excel and SPSS (IBM).
Statistical Methods:
Predictive analysis using confusion matrix, descriptive statistics, and binary logistic regression were utilized.
Results of investigation:
Among 450 patients reviewed, 214 had intraoperative frozen section examination available for comparison with permanent histopathology. There were 121 males (56.5%) and 93 females (43.5%) with a mean age of 41 years. The mean follow-up for all patients was 32.8 months with a range of 0-168 months. Compared with final permanent histopathology, the overall sensitivity of frozen sections was 92.1%. Frozen section histopathology had a sensitivity >90% and a specificity >95%, for both diagnoses of dentigerous cyst and keratocystic odontogenic tumor (KCOT). For other benign odontogenic cysts, the combined sensitivity and specificity was 93.7% and 98.4% respectively. The positive and negative predictive values were 94% and 94.2% respectively for dentigerous cyst, 92.6% and 96.9% for KCOT, and 90.9% and 98.9% for other benign odontogenic cysts. The patients who had frozen section biopsy were less likely to have recurrence (odds ratio 0.742, 95% confidence interval 0.336 to 1.640), however this was not statistically significant (P=0.462).
Conclusions relevant to the problem:
In this retrospective study of 450 patients with benign maxillofacial lesions, we found that frozen-section histopathology is a valid diagnostic modality with a high sensitivity, specificity, positive and negative predictive value. A one-stage treatment with intra-operative frozen section biopsy guiding definitive treatment eliminates the need for separate incisional biopsy, and does not affect the recurrence rate compared to a traditional two-stage treatment. Our results and analysis supports the use of frozen-section histopathology for the treatment of benign maxillofacial lesions and underscores its value in the management of these lesions.
List of two references:
1. Guthrie D, Peacock Z Sadow P, et al: Preoperative Incisional and Intraoperative Frozen Section Biopsy Techniques Have Comparable Accuracy in the Diagnosis of Benign Intraosseous Jaw Pathology. J Oral Maxillofac Surg 70:2566-2572, 2012
2. Sigurdsson G H, McAteer E: Morbidity and mortality associated with anaesthesia. Acta Anaesthesiol Scand 40:1057-1063, 1996