Bos, P.G. (2012) BETROUWBAARHEID VAN VRIESCOUPE-ONDERZOEK ALS PEROPERATIEVE CONTROLEMETHODE VAN DE SNEEVLAKKEN BIJ CHIRURGISCHEVERWIJDERING VAN PERI-OCULAIR GELOKALISEERDE BASAALCELCARCINOMEN : EEN COHORT STUDIE BETREFFENDE 139 TUMOREN. thesis, Medicine.
Full text available on request.Abstract
Introduction: In the Medical Center Leeuwarden (MCL) perioperative frozen section control is performed after excision of basal cell carcinomas (BCC’s), in cases in which reconstruction with a transposition or rotation flap is necessary. In this way complete surgical resection can be ensured and reconstruction of the created defect does not need to be postponed. In practice frozen section control is always followed by histological monitoring by paraffin sections, the gold standard for histological examination. This study was performed to determine whether the outcome of frozen section control matches with the outcome of paraffin section control, with as the main question whether frozen section control only delivers a sufficiently reliable result concerning completeness of the excision or whether post operative paraffin section control is still necessary for reliable examination of the surgical margins. Methods: In 132 patients, operated on in between 1992 and 2006 in the MCL, excision of one or more periocular localized BCC’s was performed. Perioperatively, completeness of the excision was examined through frozen section control. The outcome of the frozen section control was compared with the postoperative histological examination through paraffin section control. Based on this comparison specificity and sensitivity of frozen section control was calculated. Tumor size and growth pattern of the excised tumors, primary or recurrent, was registered as well as tumor location (medial/lateral canthus, lower/upper lid = MC, LC, LL, UL). Tumor recurrence was investigated retrospectively through patient files and the Automated Dutch National Pathology Archives. Results: In 132 patients (55% male, mean age 66,6 ±12,6 SD years) 139 periocular BCC’s were excised (51,8% MC, 8,6% LC, 36,7% LL, 2,9% UL). Of the 139 initial excisions from 130 results of paraffin section control were available; 84 with the result ‘tumor-free margins’ and 46 with the result ‘non-tumor-free margins’. 80 of the 84 excisions with tumor-free margins, according to the paraffin sections, showed tumor-free margins in the frozen sections as well (specificity 95%; 95%-CI 91-100%). In 44 of the 46 excisions with non-tumor-free margins, according to the paraffin sections, the frozen sections showed incomplete excision as well (sensitivity 96%; 95%-CI 90-100%). Average follow-up time was 79 months. Of the 139 tumors 5 (3.6%) showed recurrence. Conclusion: Frozen section control as a method for histological examination of the margins of surgically-removed periocular BCC’s has a high specificity (95%) and sensitivity (96%). It is a reliable method to check completeness of tumor excision. If frozen sections have shown complete tumor removal, immediate reconstruction of the defect can be performed. There is no need to wait until the results of paraffin section control are available. This disposes of the indication for postoperative paraffin section control.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Biezen, Dr. J.J. van der plastisch chirurg and Afdeling Plastische en Handchirurgie, Medisch Centrum Leeuwa |
| 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/2538 |
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