Intraoperative assessment of the node-negative neck with frozen section biopsy

OBJECTIVE: To determine the accuracy of intraoperative assessment of the node-negative N0 neck with frozen-section biopsy.

METHODS: In our study, 60 patients 9 women and 51 men who underwent 88 elective neck dissections with head and neck squamous cell carcinoma, in the Department of Otorhinolaryngology Medical Faculty, Cukurova University, Adana, Turkey, from January 2003 to December 2006, were reviewed retrospectively.

RESULTS: Of the 88 clinically preoperatively staged N0 necks, 22 necks 25% were shown subsequently to have metastatic disease after final pathological assessment. In 16 out of 22 cases, frozen-section biopsy revealed metastatic disease, and surgery was changed to a modified comprehensive neck dissection. In another 6 cases, the sampled lymph nodes were considered negative at frozen-section analysis, and metastatic disease was found in the final histopathologic reports. There was no false-positive result. The specificity and positive predictive values were both 100%. The sensitivity of intraoperative lymph node assessment was 73%, and the negative predictive value was 91%.

CONCLUSION: Intraoperative assessment of the N0 neck with frozen-section biopsy seems to improve the accuracy of staging and may alter the intraoperative treatment strategy.