Online ISSN: 2515-8260

Keywords : metastasis

“Assessment of lymph node status in cases of metastatic malignancy by frozen section and imprint cytology”

Dr Miheer Milind Jagtap; Dr Samarth Shukla; Dr Sunita , Vagha; Dr Ankita Tamhane; Dr Sourya Acharya; Dr. Miheer Milind , Jagtap

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 2557-2551

Abstract: Introduction: Dissemination of cancers most commonly occurs by the lymphatic
route and is generally favoured by carcinomas. The best achievable goal of any surgical
procedure is removal of all the affected tissue and leave behind healthy tissue which is
entirely free of any malignant cells. Though histopathological examination is gold
standard, it is time consuming and cannot be implemented as an intraoperative diagnostic
tool. The present study utilises frozen section analysis and touch imprint cytology as
intraoperative tools and analyses their diagnostic accuracy to detect lymph node metastasis
in comparison with routine histopathology in epithelial malignancies.
Aim: To evaluate the efficacy of intraoperative diagnosis by touch imprint cytology and
frozen section analysis for the assessment of metastatic lymph node deposits.
Materials and methods: Total 76 cases of primary malignancy with suspicious metastatic
lymph nodes were investigated. Metastatic nodes were subjected to frozen section and 
touch imprint cytology and these findings were compared with routine histopathology and
the sensitivity, specificity, positive predictive value, negative predictive value and accuracy
were calculated.
Results: The sensitivity, specificity, positive predictive value, negative predictive value and
diagnostic accuracy of frozen section was found to be 97.30%, 100%, 100%, 97.5% and
98.68%. The values of the same parameters for imprint cytology was found to be 75.68%,
100%, 100%, 81.25% and 67% respectively.
Conclusions: Frozen section analysis proved superior to imprint cytology in detecting
lymph node metastasis intraoperatively. Apart from detecting the presence of metastasis,
frozen section is able to provide details regarding micro-metastasis, macro-metastasis and
perinodal fat invasion. This study predominantly evaluated epithelial malignancies and
thus proves the utility of these two intraoperative modalities in them. It also opens new
avenues for research pertaining to the utility of these modalities in various malignant
mesenchymal tumours.



European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 1185-1190

Background: Surgery is the most well established mode of initial definitive
treatment for a majority of oral cancers. Over the past few decades, the surgical technique
of neck dissection has evolved from Radical neck dissection to Modified radical neck
dissection and then to Selective Neck Dissection.
Objectives: The main purpose of this research is to evaluate the incidence of pathologic
incursion of the carotid sheath, when noticed grossly uninvolved while doing surgery in
the patients with neck dissection for head and neck squamous cell carcinoma (HNSCC).
Methods: 80 neck dissections will be performed. Carotid Sheath will be removed separately
and methodically evaluated by well experienced head and neck pathologists by performing
hematoxylin and Eosin staining and Immunohistochemistry Analysis with Markers like
Pancytokeratin and CD34 for tumour infiltration and the occurrence of lymphatic 
tissue. Hence, if found negative than it will strongly indicate that we can modify the neck
dissections limiting upto the level of carotid sheath.
Results: Carotid Sheath is not grossly involved, removal of Carotid Sheath is not
recommended. Histologically Carotid Sheath may harbour dilated lymphatic vessels,
lymphocytes aggregates and neutrophils. Carotid Sheath, however, would not harbour any
metastatic tumour emboli from primary Oral Squamous Cell Carcinoma.
Conclusion: Not only for surgical safety but also for the shield it provides post operatively
against adjuvant radiation therapy and any infection in neck and even trickling of saliva
down the neck postoperatively by protecting vital structures it encases like Common carotid
artery, Vagus Nerve and Internal jugular vein. So far there is paucity of data in presence
of metastatic involvement of carotid Sheath. This study will give basis for preservation of
Carotid sheath during neck dissection which will reduce postoperative morbidities in head
and neck squamous cell carcinoma patients.