Positive frozen section margins predict local recurrence in R0-resected squamous cell carcinoma of the head and neck

• Close margins (<5 mm) on permanent analysis are associated with aggressive tumour characteristics like high-grade differentiation, hemangiosis, lymphangiosis and regional tumour disease.
• Close margins, advanced tumour size, nodal disease, high-grade differentiation, lymphangiosis and local recurrence are predictors for poor disease-specific survival.
• Positive frozen section margins highly predict local recurrence in R0-resected carcinomas of the head and neck. This points to a limited accuracy of frozen section analysis guiding revisional resection.

SummaryObjectivesThe purpose of this study was to analyse the impact of surgical margins on tumour recurrence and survival of patients with carcinomas of the head and neck.Material and methodsA cohort of 156 patients with primary squamous cell carcinoma of the head and neck treated by local resection with negative margins and neck dissection between 2004 and 2012 was investigated. Margin status in frozen sections and permanent paraffin tissues were analysed and compared to clinical and histopathological parameters as well as to tumour recurrence (local, regional and distant) and disease-specific survival (DSS).ResultsClose margins (<5 mm) on permanent sections were correlated to high-grade differentiation (p = 0.070), lymphangiosis (p = 0.009) and positive neck nodes (p = 0.025) implicating regional and distant recurrence (p = 0.001) as well as unfavorable DSS (p = 0.002). Positive margins on initial frozen section analysis revised into negative margins during further surgery were the strongest predictor for local recurrence in uni- and multivariate analysis (p < 0.001, hazard ratio 3.34). However, positive frozen section margins were not significantly predictive for DSS (p = 0.150). Significant predictors for DSS in univariate analysis were local recurrence (p = 0.026), T-stage (p = 0.02), N-stage (p < 0.001), grading (p = 0.02) and lymphangiosis (p = 0.001). Multivariate DSS analysis revealed lymph node metastasis (p = 0.005) and local recurrence (p = 0.017) as significant negative predictors.ConclusionClose margins on permanent sections are associated with aggressive tumour characteristics, regional and distant metastasis implicating worse DSS. The accuracy of frozen section analysis seems limited as positive frozen section margins revised into negative margins bear a high risk of local recurrence.