Utility of intraoperative frozen section analysis in risk stratification and surgical decision-making for salivary gland neoplasms of uncertain malignant potential.

Abstract

Salivary gland aspirates classified as salivary gland neoplasm of uncertain malignant potential (SUMP) under the Milan System for Reporting Salivary Gland Cytopathology pose a diagnostic challenge due to their indeterminate cytologic features. We evaluate the utility of intraoperative frozen section in risk stratification and in guiding surgical management in SUMP cases. We retrospectively reviewed 75 SUMP cases from 2019 to 2024 with paired frozen section and final pathology. Frozen section diagnoses, final pathology, and intraoperative decision-making processes were analyzed. Frozen section reclassified 89% (67/75) of cases as benign or malignant, while 11% (8/75) remained indeterminate. Excluding indeterminate cases, frozen section demonstrated a diagnostic accuracy of 96% (64/67), with a sensitivity of 81% (13/16) and a specificity of 100% (51/51). Frozen section refined risk stratification by decreasing the baseline risk of malignancy from 23% before frozen section to 6% in benign frozen section cases. Malignant and indeterminate frozen section cases had risks of malignancy of 100% and 13%, respectively (χ2 = 53.84, P < .001). The combination of intraoperative findings and frozen section results influenced surgical management: More extensive resections were performed in 15% (11/75) of patients, whereas the remainder underwent conservative surgery. Intraoperative frozen section substantially improves risk stratification and informs surgical management in SUMP, though persistent indeterminate cases underscore the need for enhanced preoperative diagnostic strategies.