Intraoperative Consultation of Laryngeal Lesions

Indications for intraoperative consultation of mucosal lesions of the upper aerodigestive tract include:

• Render a histologic diagnosis (e.g., carcinoma/dysplasia) when definitive therapeutic intervention is planned immediately:

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    In laryngeal tumors most frequent indication for use of frozen section is documentation of residual tumor status

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    Intraoperative consultation with the purpose of primary tumor diagnosis is less common and discouraged.

• Assessment of the adequacy of resection (i.e., surgical resection margins)

• Preliminary assessment of the nature of a planned procedure based on the extent and distribution of the neoplasm (e.g., subtotal versus total laryngectomy)

• Adequacy for diagnostic purposes (e.g., lymphoma)

• Determination for special handling (e.g., immunohistochemistry, flow cytometry, microbiologic cultures)

• Determination of neurotropism, lymph-vascular space invasion (LVI), or soft tissue involvement that may necessitate a more extensive resection

• If lymph nodes are excised, then a frozen section may be requested to exclude the presence of metastatic disease and the need for a neck dissection.

Establish diagnosis of carcinoma/dysplasia and differentiate it from look-alike lesions.

Confirm presence or absence of lesional tissue at the margins of resection.

When applicable, identify the presence of osseous involvement.

When applicable, identify the presence of nodal metastasis.