{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T20:43:36Z","timestamp":1770151416906,"version":"3.49.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"Importance<\/jats:title>Current guidelines recommend intraoperative frozen section(s) during diagnostic surgery for squamous cell carcinoma for unknown primary tumors (SCCUP).<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine the utility of intraoperative pathology consultation during transoral robotic surgery (TORS) in localizing primary tumors and influencing need for adjuvant therapy.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>A retrospective case series including 47 adult patients with human papillomavirus (HPV)\u2013associated SCCUP who underwent TORS\/oropharyngectomy between January 2016 and February 2023 was carried out at a single tertiary care hospital. The analysis took place on May 13, 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Nodal stage, tonsillectomy history, extranodal extension (ENE).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Intraoperative pathology consultation and final pathology results were compared with surgical outcomes, including margin revision, need for second procedure and\/or radiation with or without chemotherapy.<\/jats:p><\/jats:sec>Results<\/jats:title>This study included 47 adult patients. Mean (range) age was 61 (41-79) years; patients were mostly men (37 [79%]). Overall, primary tumors were identified in 37 patients (79%), including all cases with positive nodes involving more than 1 neck level. Patients whose primary tumor was not found tended to have tobacco use history (8\/10 vs 13\/37 [35%]; difference, 45%; 95% CI, 16%-74%) and absence of ENE (8\/10 vs 15\/37 [41%]; difference, 39%; 95% CI, 10%-68%). Primary tumor was identified intraoperatively in 18 of 37 patients (49%). SCCs identified intraoperatively were significantly larger than SCCs found on permanent sections only: mean (SE), 1.2 (0.13) cm vs 0.5 (0.1) cm (difference, 0.7 cm; 95% CI, 0.53-1.94). The sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative consultation was 49% (95% CI, 33%-64%), 100% (95% CI, 100%-100%), 100%, and 34% (95% CI, 19%-53%), respectively. Margins were revised in 11 of 18 patients (61%) whose primary tumor was identified intraoperatively (during original procedure) and in 3 of 19 patients (16%) whose primary tumor was identified on permanent pathologic findings only (during a second procedure) (11\/18 [61%] vs 3\/19 [16%]; difference, 45%; 95% CI, 17%-73%). However, there was no significant difference in the use of adjuvant radiotherapy with or without chemotherapy or need for a second procedure based on intraoperative primary tumor localization.<\/jats:p><\/jats:sec>Conclusion and Relevance<\/jats:title>In this case series study, the sensitivity and negative predictive value of intraoperative pathology consultation among 47 patients was less than 50%. Given the lack of influence on the need for radiotherapy with or without chemotherapy or second procedure, the practical utility of routine intraoperative frozen section requires further scrutiny.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2024.2011","type":"journal-article","created":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T15:01:52Z","timestamp":1721314912000},"page":"792","source":"Crossref","is-referenced-by-count":3,"title":["Intraoperative Pathology Consultation in Patients With p16-Positive Unknown Primary Squamous Cell Carcinoma"],"prefix":"10.1001","volume":"150","author":[{"given":"Daniel R.","family":"Awad","sequence":"first","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anisha","family":"Konanur","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Washington, Seattle"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert L.","family":"Ferris","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seungwon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umamaheswar","family":"Duvvuri","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"},{"name":"Presently at Department of Otolaryngology, New York University, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simion I.","family":"Chiosea","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Pittsburgh 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