Accuracy of frozen section for HPV-Associated squamous cell carcinoma of unknown primary

IF 3.9 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI:10.1016/j.oraloncology.2026.107861

Sindhura Sridhar , Annie Moroco , Shravan Gowrishankar , Mitra Mehrad , Kim Ely , James S. Lewis , Madalina Tuluc , Stacey Gargano , Melanie Hicks , Kyle Mannion , Arielle G. Thal , Adam J. Luginbuhl , Joseph M. Curry , David M. Cognetti , Michael C. Topf

{"title":"Accuracy of frozen section for HPV-Associated squamous cell carcinoma of unknown primary","authors":"Sindhura Sridhar , Annie Moroco , Shravan Gowrishankar , Mitra Mehrad , Kim Ely , James S. Lewis , Madalina Tuluc , Stacey Gargano , Melanie Hicks , Kyle Mannion , Arielle G. Thal , Adam J. Luginbuhl , Joseph M. Curry , David M. Cognetti , Michael C. Topf","doi":"10.1016/j.oraloncology.2026.107861","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Current guidelines for the management of metastatic squamous cell carcinoma of unknown primary (SCCUP) recommend submission of suspicious primary sites for frozen section analysis (FSA). This study aims to investigate the diagnostic accuracy of FSA for identification of HPV-associated SCCUP.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of patients with biopsy-proven p16-positive SCCUP who underwent diagnostic operation at two tertiary care institutions was performed. Sensitivity, specificity, PPV, and NPV of diagnostic FSA were assessed.</div></div><div><h3>Results</h3><div>77 patients were included in analysis. 66 patients underwent definitive TORS (diagnostic TORS operation with subsequent neck dissection after identification of the occult primary tumor), 7 patients underwent diagnostic TORS (TORS to identify occult primary tumor, no neck dissection), and 4 patients underwent direct laryngoscopy and biopsy only. Primary tumors were identified in 63 patients (82%) with a mean tumor size of 1.1 cm. There was no significant difference in size between patients whose tumor was identified on FSA (mean 1.1 cm) and on permanent only (mean 0.9 cm) (p = 0.26). The sensitivity, specificity, PPV, and NPV of FSA for SCCUP was 86%, 100%, 100%, and 86%, respectively. Diagnostic frozen specimens included 52 direct laryngoscopy biopsies and 69 TORS excisions. In the biopsies, sensitivity was 100% and NPV was 100%, whereas in the TORS-excised specimens, sensitivity was 77% and NPV was 77%.</div></div><div><h3>Conclusions</h3><div>In this case series of 77 patients with SCCUP, the sensitivity and NPV of FSA for identification of the primary tumor was over 85%. FSA is valuable during diagnostic operation for SCCUP.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"174 ","pages":"Article 107861"},"PeriodicalIF":3.9000,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oral oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S136883752600014X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/19 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Current guidelines for the management of metastatic squamous cell carcinoma of unknown primary (SCCUP) recommend submission of suspicious primary sites for frozen section analysis (FSA). This study aims to investigate the diagnostic accuracy of FSA for identification of HPV-associated SCCUP.

Methods

A retrospective cohort study of patients with biopsy-proven p16-positive SCCUP who underwent diagnostic operation at two tertiary care institutions was performed. Sensitivity, specificity, PPV, and NPV of diagnostic FSA were assessed.

Results

77 patients were included in analysis. 66 patients underwent definitive TORS (diagnostic TORS operation with subsequent neck dissection after identification of the occult primary tumor), 7 patients underwent diagnostic TORS (TORS to identify occult primary tumor, no neck dissection), and 4 patients underwent direct laryngoscopy and biopsy only. Primary tumors were identified in 63 patients (82%) with a mean tumor size of 1.1 cm. There was no significant difference in size between patients whose tumor was identified on FSA (mean 1.1 cm) and on permanent only (mean 0.9 cm) (p = 0.26). The sensitivity, specificity, PPV, and NPV of FSA for SCCUP was 86%, 100%, 100%, and 86%, respectively. Diagnostic frozen specimens included 52 direct laryngoscopy biopsies and 69 TORS excisions. In the biopsies, sensitivity was 100% and NPV was 100%, whereas in the TORS-excised specimens, sensitivity was 77% and NPV was 77%.

Conclusions

In this case series of 77 patients with SCCUP, the sensitivity and NPV of FSA for identification of the primary tumor was over 85%. FSA is valuable during diagnostic operation for SCCUP.

查看原文本刊更多论文

原发不明的hpv相关鳞状细胞癌冷冻切片的准确性。

简介：目前关于不明原发转移性鳞状细胞癌（SCCUP）的治疗指南建议提交可疑原发部位进行冷冻切片分析（FSA）。本研究旨在探讨FSA诊断hpv相关SCCUP的准确性。方法：回顾性队列研究活检证实的p16阳性SCCUP患者在两家三级医疗机构进行诊断性手术。评估诊断性FSA的敏感性、特异性、PPV和NPV。结果：77例患者纳入分析。66例患者行明确性TORS（诊断性TORS手术，发现隐蔽性原发肿瘤后进行颈部清扫），7例患者行诊断性TORS（通过TORS识别隐蔽性原发肿瘤，不进行颈部清扫），4例患者仅行直接喉镜检查和活检。原发肿瘤63例（82%），平均肿瘤大小为1.1 cm。在FSA（平均1.1 cm）和永久（平均0.9 cm）上发现肿瘤的患者之间，肿瘤大小无显著差异（p = 0.26）。FSA对SCCUP的敏感性、特异性、PPV和NPV分别为86%、100%、100%和86%。诊断性冷冻标本包括52例直接喉镜活检和69例TORS切除。活检灵敏度为100%，NPV为100%，而在tors切除标本中，灵敏度为77%，NPV为77%。结论：本组77例SCCUP患者中，FSA鉴别原发肿瘤的敏感性和NPV均在85%以上。FSA在SCCUP的诊断手术中很有价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.