Hutting, K.H. (2015) Vriescoupe-gecontroleerde excisie als effectieve behandeling van niet-melanocytaire huidmaligniteiten in het gezicht; een scenario voor telepathologie. thesis, Medicine.
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Abstract
Introduction: NMSC’s (Non-Melanotic Skin Cancers) are malignancies of the skin, consisting of basal cell carcinoma’s (BCC’s) and squamous cell carcinoma’s (PCC’s). These tumours are frequently located in the head and neck area, where locally invasive and destructive growth can cause serious secondary morbidity. Surgical excision with frozen-section margins (VCE) is proven to be an effective treatment. Peroperative frozen-section analysis of margins is performed to evaluate the completeness of the excision, before reconstructive surgery is performed to close the surgical defect. To be able to treat facial NMSC’s in a cost-effective manner, this study was designed to confirm the reliability and effectiveness of VCE. A financial analysis was also performed to determine the costs of VCE in the current situation, and to investigate whether the use of a ‘Whole Slide Imaging’ (WSI) telepathology-system can result in cost reduction. Materials and methods: Results of the peroperative frozen-section analysis of margins in NMSC’s, previously treated with VCE, were compared with the results of the postoperative paraffin-section control, which is the gold standard. The percentage of corresponding results was calculated, at which the sensitivity and specificity of the frozen-section analysis were determined. The rate and incidence of recurrence were used to express the effectiveness of VCE as treatment of facial NMSC’s. These were investigated retrospectively in treated NMSC’s with a completed follow-up time of at least 3 months, using patient files. The financial analysis was performed on a model study population, that was created by correcting the costs and results of the current treatment for the estimated effects of WSI. Results: 910 NMSC’s were treated with VCE in 827 patients (50,2% men, mean age 69,3 years). The results of the frozen-section analysis of margins were confirmed by postoperative paraffin-section control in 98,5% (95%- confidence interval (CI): 97,5-99,3%) of cases. The sensitivity was 68,8% (95%-CI: 41,3-89,0%), and the specificity was 99,9% (95%-CI: 99,3-100,0%). A follow-up time of at least 3 months was completed in 504 of the total 910 included cases. Within this group, 22 (4,37% (95%-CI: 2,83-6,43%) recurrences were discovered. The mean completed follow-up time in this group was 24,4 months. An incidence-rate of 2,18 (95%-CI: 1,40-3,25) per 100 person-years was calculated from the total completed follow-up time. The sensitivity and specificity of the frozen-section margin analysis did not differ significantly between BCC’s and PCC’s, and neither did the recurrence rate. The relative risk of developing a recurrence was 0,34 (95%-CI: 0,31-0,94) for BCC’s compared to PCC’s, which differed significantly. The average costs of treatment in the current situation were €1450. Costs of VCE with WSI were estimated at €1293 per treatment. Therefore, the estimated cost reduction was €157 (10,8%, range: 7,6-11,5%) per treatment. Conclusion: The frozen-section analysis highly corresponds with the postoperative paraffin-section control. Its sensitivity and specificity is acceptable for evaluating the completeness of excisions of both BCC’s and PCC’s. The effectiveness of VCE as a treatment of facial NMSC’s has been proven with a low rate and incidence of recurrence. The use of a WSI-system results in an estimated cost reduction of 10,8%. Therefore, VCE with WSI seems suitable for cost-effective treatment of facial NMSC’s.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Mouës-Vink, Dr. C.M. and Afdeling Plastische chirurgie en Handchirurgie and Medisch Centrum Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2501 |
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