ABSTRACT
BACKGROUND: There has been little written concerning the use of frozen sections to diagnose skin lesions. OBJECTIVE: To compare the concordance between frozen and permanent sections of the same diagnostic skin biopsy specimen. METHODS AND MATERIALS: Over 3 months, all non-melanocytic skin lesions that were biopsied in a skin cancer clinic were examined using frozen and permanent sections. Diagnoses from a dermatologist and dermatopathologist were recorded for each specimen and later examined for concordance. RESULTS: There was rare (0.5% of specimens) disagreement recorded between interpretations of the dermatologist and dermatopathologist. Permanent and frozen section pathology agreed with one another 90.4% of the time. Specimen processing was the most probable cause of discordance. Most discordance was not clinically relevant, although the patient was clinically affected in 35 of 2009 specimens (1.7%). CONCLUSION: Although there is a high concordance rate between diagnostic frozen and permanent sections, there are significant quality assurance and patient care advantages to following up initial diagnostic frozen sections with permanent sections of the same specimen.
Subject(s)
Ambulatory Care , Biopsy , Dermatology , Frozen Sections , Pathology, Clinical , Skin Diseases/pathology , Humans , Observer Variation , Reproducibility of ResultsABSTRACT
OBJECTIVE: To define the rate of complications from surgery following intensive chemoradiotherapy in patients with advanced squamous cell carcinoma of the head and neck. DESIGN: The medical records of 131 consecutive patients treated with a combination of chemotherapy and radiation therapy for head and neck squamous cell carcinoma from 1995 through 2002 were reviewed. Thirty-eight patients underwent 50 surgical procedures. Thirty-seven neck dissections were performed either for persistent disease, initial neck stage N2 or greater, recurrent disease, or electively as part of salvage surgery for the primary site. Thirteen salvage operations were performed for persistent or recurrent disease at the primary site. SETTING: Academic tertiary care referral center. PATIENTS: A total of 131 consecutive patients treated with a combination of chemotherapy and radiation therapy for head and neck squamous cell carcinoma (mean age at diagnosis, 53 years). MAIN OUTCOME MEASURE; Rate of complications from surgery. RESULTS: Wound complications occurred in 4 (11%) of 38 patients and 5 (10%) of 50 procedures. Major wound complications occurred in 3 (8%) of 38 patients. Minor wound complications occurred in 2 patients (5%). CONCLUSION: Surgery can be safely performed after intensive chemoradiotherapy.
Subject(s)
Carcinoma, Squamous Cell/therapy , Head and Neck Neoplasms/therapy , Carcinoma, Squamous Cell/surgery , Combined Modality Therapy , Cutaneous Fistula/etiology , Female , Fistula/etiology , Head and Neck Neoplasms/surgery , Humans , Male , Middle Aged , Neck Dissection , Pharyngeal Diseases/etiology , Postoperative Complications , Salvage TherapyABSTRACT
Malignant neoplasms involving the temporal bone are a relatively rare and often misdiagnosed disease. Staging of temporal bone cancer has proven difficult because of the small number of patients with this condition, the various histopathologic and histologic findings reported, and a lack of randomized trials. Of the various staging systems that have been proposed, the Pittsburgh classification appears to be the most widely accepted. A retrospective study of 31 patients with temporal bone malignancy at the University of Arkansas for Medical Sciences has led us to propose a modification of the Pittsburgh classification for early-stage lesions. This modification places more emphasis on the site of disease in the canal and less on the size of the primary tumor or degree of bony invasion. This review discusses this staging system, the management of these tumors in a multidisciplinary team approach, reconstructive options, and auditory rehabilitation.
