The Reliability of Intraoperative Frozen Section for Glottic Lesions Suspected of Early Malignancy

OBJECTIVE: Glottic lesions suspected of malignancy may be treated by laser cordectomy. Although obviating the preoperative biopsy can expedite treatment and preserve the surgical planes, it poses a risk of mistreatment. This study sought to determine if intraoperative frozen section (FS) prior to cordectomy can reliably guide lesion management. STUDY DESIGN: Retrospective chart review, 2017 to 2024. SETTING: Two tertiary university-affiliated referral centers. METHODS: Patients who underwent intraoperative FS sampling of glottic lesions suspected of early malignancy were identified. In all cases, samples were obtained from the area with the most suspicious characteristics using cold instruments. To determine accuracy, the FS results were compared with the final pathology report using 2 binary categorization systems: invasiveness (SCC present/absent) and malignant potential (lesion warrants/does not warrant curative cordectomy). Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated. RESULTS: Ninety-one vocal-fold lesions obtained from 70 patients in 81 surgeries were included. FS analysis detected invasive carcinoma with 94.5% accuracy; there were no false-positives. While examining malignant potential, the accuracy was 94.5%, with 37 true-positives, 49 true-negatives, 2 false-positives, and 3 false-negatives. The calculated sensitivity, specificity, PPV and NPV were 92%, 96%, 95% and 94%, respectively. CONCLUSIONS: Intraoperative FS is a reliable tool for the identification of early malignancy in suspicious glottic lesions, especially invasive carcinoma. The high PPV and NPV for high malignant potential suggest that intraoperative FS, combined with clinical judgment, may guide surgeons' decision-making.