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