Frozen Section Pathology for Decision Making in Parotid Surgery

IMPORTANCE For parotid lesions, the high accuracy and utility of intraoperative frozen section (FS) pathology, compared with permanent section pathology, facilitates intraoperative decision making about the extent of surgery required. OBJECTIVE To demonstrate the accuracy and utility of FS pathology of parotid lesions as one factor in intraoperative decision making. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of patients undergoing parotidectomy at a tertiary care center. INTERVENTIONS Evaluation of the accuracy of FS pathology for parotid surgery by comparing FS pathology results with those of permanent section. MAIN OUTCOMES AND MEASURES Documented changes from FS to permanent section in 1339 parotidectomy pathology reports conducted from January 1, 2000, through December 31, 2009, included 693 benign and 268 primary and metastatic malignant tumors. RESULTS Changes in diagnosis were found from benign to malignant (n = 11) and malignant to benign (n = 2). Sensitivity and specificity of a malignant diagnosis were 98.5% and 99.0%, respectively. Other changes were for lymphoma vs inflammation or lymphoma typing (n = 89) and for confirmation of or change in tumor type for benign (n = 36) or malignant (n = 69) tumors. No case changed from low- to high-grade malignant tumor. Only 4 cases that changed from FS to permanent section would have affected intraoperative decision making. Three patients underwent additional surgery 2 to 3 weeks later. Overall, only 1 patient was overtreated (lymphoma initially deemed carcinoma). CONCLUSIONS AND RELEVANCE Frozen section pathology for parotid lesions has high accuracy and utility in intraoperative decision making, facilitating timely complete procedures.