Comparativestudy Of Frozen Section Biopsy And Routine Pathological Evaluation In The Diagnosis Of Laryngeal Cancer And Hypopharyngeal Cancer

Purpose:Laryngeal cancer(LC)and hypopharyngeal cancer(HPC)are common types of head and neck cancer.Main treatment of laryngeal and hypopharyngeal cancers includes surgery,radiotherapy and chemotherapy,etc.Surgery combined with radiotherapy/chemotherapy is especially conducted in advanced patients.A biopsy is required in the primary site of tumor for further evaluation.Fibrolaryngoscopewith local anesthesia and self-retaining laryngoscope with general anesthesia are often used for biopsy,and either routine pathological evaluationor frozen section diagnosis could be carried out in biopsy by self-retaining laryngoscope.Diagnosis is less likely be confirmed by fibrolaryngoscopewithlocal anesthesia at one time due to the difficulty of biopsy procedure,patient intolerance and less amount of specimen,leading to a repeated procedure.Biopsy by self-retaining laryngoscope with general anesthesia and routine pathological evaluation often results in a second time surgery after confirmed pathological diagnosis.Frozen section diagnosis could be done during surgery,but the chance of false positive or negative result reduces its accuracy.Therefore,the choice of bioptic and diagnostic procedure remains controversial.In recent years,preservation of laryngeal function became a prominent subject of surgical treatment of LC and HPC,while more preserved tissue might predicts positive surgical margin,consequently affecting choice of treatment,function preservation and prognosis.So the balance between thorough primary tumorectomy and laryngeal function preservation has to be carefully considered.This study aims to discuss the application value and practicability of frozen section diagnosis of surgical margin during surgery.Methods:A retrospective analysis of pre-surgery laryngostroboscopic images and medical imaging data is carried out on 238 patients who underwent surgery and were diagnosed as LC or HPC in the First Affiliated Hospital Zhejiang University.Coincidence of diagnosis by frozen section biopsy androutine evaluation is analyzed.Relapse or survival of patients are acquired through outpatient medical records and relephone follow-up.Result:1.Coincidence of primary foci diagnosis by frozen section biopsy and routine evaluation is 94.6%in patients with a final confirmed diagnosis as LC or HPC.2.Coincidence of surgical margin diagnosis by frozen section biopsy and routineevaluation is 100%.21 out of 201 LC and HPC provides a positive surgical margin at the first time of biopsy,making up 10.4%of the patients.Conclusion:Diagnosis by frozen section biopsy in primary siteand surgical margin is practical,providing the evidence of possibility of only one surgical treatment.