Background: Eradication of malignant tumors at the primary site with oncological safe margin is a critical requirement for obtaining better survival rate and less recurrence. Touch imprint cytology (TIC) has proven itself as a quick, simple, inexpensive, highly accurate and reliable intraoperative technique to assess surgical margins in squamous cell carcinomas of the oral cavity. However, it is still unclear how the mode of excision, i.e. by scalpel (SC) and electrocautery (EC), or the method of staining, i.e. Papanicolaou (PAP) and cytohaem, affect the diagnostic accuracy of TIC. Objective: To study the influence of confounding factors like mode of excision (EC/SC) and staining (PAP/cytohaem) on the diagnostic accuracy of intraoperative TIC technique for assessing surgical margins in oral squamous cell carcinoma in comparison to paraffin-embedded HE-stained sections. Materials and Methods: Thirty patients underwent surgical treatment for primary oral squamous cell carcinoma. Three hundred and forty-eight touch imprint slides were prepared from 174 margins of 30 resected tumor specimens. Two adjacent tissues from the margin to be evaluated were imprinted to observe differences between surfaces excised by EC and SC. The set of imprint from each margin tissue was stained with PAP and cytohaem. The TIC results of 180 EC-excised margins and 168 SC-excised margins were compared. Results of 174 imprints stained with RAPID-PAP were compared to their counterpart comprising of 174 cytohaem-stained imprints. The slides were diagnosed as positive, negative or suspicious for tumor. Finally, TIC results were checked against their respective histopathological sections. Results: No statistically significant difference was found between the results of imprints from EC/SC-excised margins (Z = 0.44, p = 0.70) or the imprints stained with PAP/cytohaem (Z = 0.44, p = 0.70). Conclusion: Confounding factors like mode of excision and staining procedure do not significantly influence the results of imprint cytology.

Waruna Dissanayaka L, Pitiyage G, Vithanage P, Kumarasiri R, Liyanage RLPR, Dias KD, Tilakaratne WL: Clinical and histopathologic parameters in survival of oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2012;113:518-525.
Yadav GS, Donoghue M, Tauro DP, Yadav A, Agarwal S: Intraoperative imprint evaluation of surgical margins in oral squamous cell carcinoma. Acta Cytol 2013;57:75-83.
Liboon J, Funkhouser W, Terris DJ: A comparison of mucosal incisions made by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery. Otolaryngol Head Neck Surg 1997;116:379-385.
Carew JF, Ward RF, LaBruna A, Torzilli PA, Schley WS: Effects of scalpel, electrocautery, and CO2 and KTP lasers on wound healing in rat tongues. Laryngoscope 1998;108:373-380.
Brodman M: Electrocautery devices, the way they work! Contemp Ob/Gyn 2007;52:85-93.
Beriat GK, Akmansu SKH, Ezerarslan H, Dogan C, Han U, Saglam M, Senel OO, Kocaturk S: The comparison of thermal tissue injuries caused by ultrasonic scalpel and electrocautery use in rabbit tongue tissue. Bosn J Basic Med Sci 2012;12:151-157.
Arashiro DS, Rapley JW, Cobb CM, Killoy WJ: Histologic evaluation of porcine skin incisions produced by CO2 laser, electrosurgery and scalpel. Int J Periodont Res 1996;16:479-491.
Noble WH, McClatchey KD, Douglass GD: A histologic comparison of effects of electrosurgical resection using different electrodes. J Prosthet Dent 1976;35:575-579.
Laucirica R: Intraoperative assessment of the breast. Guidelines and potential pitfalls. Arch Pathol Lab Med 2005;129:1565-1574.
Songra AK, Ng SY, Farthing P, Hutchison IL, Bradley PF: Observation of tumour thickness and resection margin at surgical excision of primary oral squamous cell carcinoma - assessment by ultrasound. Int J Oral Maxillofac Surg 2006;35:324-331.
Kontozoglou TE, Cramer HM: The advantages of intraoperative cytology. Analysis of 215 smears and review of the literature. Acta Cytol 1991;35:154-164.
Directorate General of Health Services, Ministry of Health: Manuals for training in cancer control. National Cancer Control Program, November 2005.
Sivapathasundharam B, Kalasagar M: Yet another article on exfoliative cytology. J Oral Maxillofac Pathol 2004;8:54-57
Kamal MM, Kulkarni MM,·Wahane RN: Ultrafast Papanicolaou Stain modified for developing countries: efficacy and pitfalls. Acta Cytol 2011;55:205-212.
Jorundsson E, Lumsden JH, Jacobs RM: Rapid staining techniques in cytopathology: a review and comparison of modified protocols for hematoxylin and eosin, Papanicolaou and Romanowsky stains. Vet Clin Path 1999;28:100-108.
Motomura K, Nagumo S, Komoike Y, Koyama H, Inaji H: Intraoperative imprint cytology for the diagnosis of sentinel node metastases in breast cancer. Breast Cancer 2007;14:350-353.
Anand M, Kumar R, Jain P, Asthana S, Deo SV, Shukla NK, Karak A: Comparison of three different staining techniques for intraoperative assessment of nodal metastasis in breast cancer. Diagn Cytopathol 2004;31:423-426.
Idris AAA, Hussain MS: Comparison of the efficacy of three stains used for the detection of cytological changes in Sudanese females with breast lumps. Sudan J Publ Health 2009;4:275-277.
Asthana S, Deo SV, Shukla NK, Jain P, Anand M, Kumar R: Intraoperative neck staging using sentinel node biopsy and imprint cytology in oral cancer. Head Neck 2003;25:368-372.
Florell SR, Layfield LJ, Gerwels JW: A comparison of touch imprint cytology and Mohs frozen-section histology in the evaluation of Mohs micrographic surgical margins. J Am Acad Dermatol 2001;44:660-664.
Hussein MR, Rashad UM, Hassanein KA: Touch imprint cytologic preparations and the diagnosis of head and neck mass lesions. Ann Oncol 2005;16:171-172.
Creager AJ, Shaw JA, Young PR, Geisinger KR: Intra-operative evaluation of lumpectomy margins by imprint cytology with histologic correlation: a community hospital experience. Arch Pathol Lab Med 2002;126:846-848.
Weinberg E, Cox C, Dupont E, White L, Ebert M, Greenberg H, et al: Local recurrence in lumpectomy patients after imprint cytology margin evaluation. Am J Surg 2004;188:349-354.
Pugliese MS, Kohr JR, Allison KH, Wang NP, Tickman RJ, Beatty JD: Accuracy of intraoperative imprint cytology of sentinel lymph nodes in breast cancer. Am J Surg 2006;192:516-519.
Bakhshandeh M, Tutuncuoglu SO, Fischer G, Masood S: Use of imprint cytology for assessment of surgical margins in lumpectomy specimens of breast cancer patients. Diagn Cytopathol 2007;35:656-659.
Saarela AO, Paloneva TK, Rissanen TJ, Kiviniemi HO: Determinants of positive histologic margins and residual tumor after lumpectomy for early breast cancer: a prospective study with special reference to touch preparation cytology. J Surg Oncol 1997;66:248-253.
Klimberg VS, Westbrook KC, Korourian S: Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol 1998;5:220-226.
Kiminari K, Koji S, Ritsuo M, Kaori U, Haruhiko M, No A, Reiki N: Intraoperative rapid imprint cytology of surgical margin in breast conserving surgery. J Japan Soc Clin Cytol 2004;35:63-68.
Wright TC, Richart RM, Ferenczy A, Koulos J: Comparison of specimens removed by CO2 LASER conization and the loop electrosurgical excision procedure. Obstet Gynecol 1992;79:147-153.
Sutton DN, Brown JS, Rogers SN, Vaughan JA, Wooglar JA: The prognostic implications of the surgical margin in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2003;32:30-34.
Langdon JD, Partridge M: Expression of the tumour suppressor gene p53 in oral cancer. Br J Oral Maxillofac Surg 1992;30:214-220.
Anneroth G, Batsakis J, Luna M: Review of the literature and a recommended system of malignancy grading in oral squamous cell carcinomas. Scand J Dent Res 1987;95:229-249.
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