Role of Frozen Section in Neck Dissection of Oral Cancer Patients

Abstract

Introduction: Oral carcinoma is emerging as growing problem in many areas of the World and 4th most
common cancer among women in India. Globally, over 3,00,000 people are diagnosed with oral cavity
cancer each year. Radical or modified radical neck dissection is usually a choice of surgeon in node positive
patients. Frozen section when performed along with supra-omohyoid neck dissection provides solution to
this dilemma of surgeon by detecting the metastasis in cervical lymph nodes intra-operatively during neck
dissection. This study was planned to establish usefulness of frozen section examination in decision of
correct plan of management of patients of oral cancer with clinically nonodal metastasis in neck (N0).
Objectives: To study appropriate plan of management for clinically neck examination with lymph node
status N0 in patients of oral cancer and to determine efficacy of frozen section examination in detection of
occult nodal metastasis in neck in patients of oral cancer.
Method and Materials: In 102 cases, excision of lesion, followed by supra-omohyoid neck dissection was
primary mode of treatment and lymph nodes at various levels were sent to frozen section for assessment of
metastasis by cancer cells. Intraoperatively during frozen section,if any of the lymphnode between levels
I to levels III is found positive for the metastatic disease then the plan of surgery was changed to a more
comprehensive Modified radical neck dissection.
Results: Maximum cases were carcinoma tongue followed by cases of carcinoma of gingiva-buccalsulcus.
Carcinomas of stage 1,stage 2,stage 3 are 43.8%, 52.2% and 3.9%. Histopathological grading of oral
squamous cell carcinoma was done by Broader’s grading system as Well differentiated SCC (52 cases),
Moderately differentiated SCC (42 cases), poorly differentiated SCC (08 cases). Supra-omohyoid neck
dissection was initial plan of management in cases but it changed to modified radical neck dissection in 42
cases as lymph nodes between level 1 to 3 were positive for metastasis of SCC.
Conclusion: Oral cancer should be surgically managed intra-operatively by frozen section examination of
alllymph nodes to avoid short term recurrences and institution of post-surgicalchemo/radiotherapy. Frozen
section examination of yielded lymph nodes in these surgeries canmodify the extent of dissection of neck.