Frozen section examination

When considering all head and neck sites, the accuracy of frozen section diagnoses of the salivary gland is the most controversial. A review of 2460 frozen sections from 24 series revealed an overall accuracy rate for a benign or malignant diagnosis, excluding deferred diagnoses, of 96% {379,900,1697,2170, 2900}. False-positive rates (benign tumours initially diagnosed as malignant) were 1.1%, false-negative rates (malignant tumours initially diagnosed as benign) were 2.6%, and 2% of cases were deferred. If one subdivides the salivary gland lesions into benign and malignant groups, the accuracy rate (98.7%, excluding deferred diagnoses) is excellent for the benign lesions, which compose 80% of the frozen sections. However, in the malignant tumour group, the accuracy rate (85.9%) is suboptimal {900}.

The most common benign tumour over-diagnosed as malignant was pleomor-phic adenoma. This was frequently called mucoepidermoid carcinoma or adenoid cystic carcinoma {904}. Mucoepidermoid carcinoma is the malignancy most frequently associated with a false negative benign frozen section diagnosis, while acinic cell carcinoma, adenoid cystic carcinoma, carcinoma ex pleomorphic adenoma and an occasional lymphoma have also caused difficulty.

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