Frozen Section Assessment of Bronchial Margins during Lung Carcinoma Surgeries: Report of the Experience at a Single Institution

Abstract

Introduction Many thoracic surgeons consider frozen section analysis of bronchial margins during lobectomies “obligatory” although routine frozen section analysis of the bronchial margin rarely yields positive results and infrequently changes intra-operative management in patients undergoing Non-Small Cell Lung Carcinoma (NSCLC) resection. Materials and methods 234 cases of lobectomies with carcinoma were reviewed at our institution to assess bronchial margin involvement, correlation between frozen section and final bronchial margin status, gross distance between tumor and margin, and tumor type. Results Tumor distance to margin varied in the 234 cases from grossly involved to 10 cm away. 5 cases out of 234 (approximately 2.1%) had a positive bronchial margin in the final report. 3 out of the 5 cases were poorly differentiated squamous cell carcinoma grossly abutting the bronchial margin, two cases were of poorly differentiated adenocarcinoma located grossly 0.5 cm away from the bronchial margin. 4 out of 5 cases were called positive intra-operatively. In none of the 4 out of the 5 positive cases did frozen section exam of the bronchial margins change the intra-operative management of the case. Conclusion Our study supports selective use of intra-operative frozen section of bronchial margins during lobectomies for carcinoma. On the basis of our findings, a distance of approximately 1 cm or less is suggested as a threshold for intra-operative microscopic examination of the bronchial margins. However, routine examination of the bronchial margins, regardless of the location of the tumor upon gross examination, and in the absence of empirical evidence supporting this practice, is only time consuming intra-operatively, wasteful of resources and has no therapeutic or prognostic value.