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CO(2) laser versus cold steel margin analysis following endoscopic excision of glottic cancer.

Makki FM, Rigby MH, Bullock M, Brown T, Hart RD, Trites J, Hinni ML, Taylor SM - J Otolaryngol Head Neck Surg (2014)

Bottom Line: Prospective randomized blinded study.Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique. 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable.Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Division of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. smtaylorwashu@yahoo.com.

ABSTRACT

Objective: To compare the suitability of CO2 laser with steel instruments for margin excision in transoral laser microsurgery.

Methods: Prospective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO2 laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique.

Results: 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24).

Conclusion: Laser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability.

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Related in: MedlinePlus

Examples of histological grading system for artifact. A)None: Well preserved surface epithelium, seromucinous glands and stroma. B)Minor: Well preserved surface epithelium. Seromucinous glands show some indistinct hyperchromatic areas (arrow). C)Marked: Surface epithelium is partially denuded with remainder showing severe artifact (arrow). Lamina propria is relatively preserved and can be assessed for invasive carcinoma (asterisk). D)Uninterpretable: Fragmented margin tissue with detached surface epithelium (arrow) and indistinct fragments of lamina propria.
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Figure 2: Examples of histological grading system for artifact. A)None: Well preserved surface epithelium, seromucinous glands and stroma. B)Minor: Well preserved surface epithelium. Seromucinous glands show some indistinct hyperchromatic areas (arrow). C)Marked: Surface epithelium is partially denuded with remainder showing severe artifact (arrow). Lamina propria is relatively preserved and can be assessed for invasive carcinoma (asterisk). D)Uninterpretable: Fragmented margin tissue with detached surface epithelium (arrow) and indistinct fragments of lamina propria.

Mentions: All margin specimens were sent to the same pathologist who was blinded to margin excision technique. Prior to the study, a trial of margin excision using both techniques was performed and reviewed with the pathologist to assess for obvious signs of thermal artifact. On histological analysis there weren’t any obvious difference between the two techniques, which allowed for blinding of the pathologist to technique. Histopathology slides were prepared as per standard protocol. The specimens were fixed in 10% formalin immediately following excision, paraffin-embedded and then 5-micron sections were stained with hematoxylin and eosin. For each margin, the pathologist was provided with three levels through the tissue at approximately 40-micron intervals. All margin specimens were examined for their size (following formalin fixation but prior to embedding in paraffin), malignancy/dysplasia status, and degree of artifact. For the study artifact was defined as an alteration of tissue or cellular structures that resulted from an external factor. The degree of artifact was divided into: none, minor, marked, and uninterpretable as defined in Table 1 and shown in Figure 2.


CO(2) laser versus cold steel margin analysis following endoscopic excision of glottic cancer.

Makki FM, Rigby MH, Bullock M, Brown T, Hart RD, Trites J, Hinni ML, Taylor SM - J Otolaryngol Head Neck Surg (2014)

Examples of histological grading system for artifact. A)None: Well preserved surface epithelium, seromucinous glands and stroma. B)Minor: Well preserved surface epithelium. Seromucinous glands show some indistinct hyperchromatic areas (arrow). C)Marked: Surface epithelium is partially denuded with remainder showing severe artifact (arrow). Lamina propria is relatively preserved and can be assessed for invasive carcinoma (asterisk). D)Uninterpretable: Fragmented margin tissue with detached surface epithelium (arrow) and indistinct fragments of lamina propria.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927765&req=5

Figure 2: Examples of histological grading system for artifact. A)None: Well preserved surface epithelium, seromucinous glands and stroma. B)Minor: Well preserved surface epithelium. Seromucinous glands show some indistinct hyperchromatic areas (arrow). C)Marked: Surface epithelium is partially denuded with remainder showing severe artifact (arrow). Lamina propria is relatively preserved and can be assessed for invasive carcinoma (asterisk). D)Uninterpretable: Fragmented margin tissue with detached surface epithelium (arrow) and indistinct fragments of lamina propria.
Mentions: All margin specimens were sent to the same pathologist who was blinded to margin excision technique. Prior to the study, a trial of margin excision using both techniques was performed and reviewed with the pathologist to assess for obvious signs of thermal artifact. On histological analysis there weren’t any obvious difference between the two techniques, which allowed for blinding of the pathologist to technique. Histopathology slides were prepared as per standard protocol. The specimens were fixed in 10% formalin immediately following excision, paraffin-embedded and then 5-micron sections were stained with hematoxylin and eosin. For each margin, the pathologist was provided with three levels through the tissue at approximately 40-micron intervals. All margin specimens were examined for their size (following formalin fixation but prior to embedding in paraffin), malignancy/dysplasia status, and degree of artifact. For the study artifact was defined as an alteration of tissue or cellular structures that resulted from an external factor. The degree of artifact was divided into: none, minor, marked, and uninterpretable as defined in Table 1 and shown in Figure 2.

Bottom Line: Prospective randomized blinded study.Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique. 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable.Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Division of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. smtaylorwashu@yahoo.com.

ABSTRACT

Objective: To compare the suitability of CO2 laser with steel instruments for margin excision in transoral laser microsurgery.

Methods: Prospective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO2 laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique.

Results: 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24).

Conclusion: Laser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability.

Show MeSH
Related in: MedlinePlus