Cytopathologic assessment of gloves and instruments after major head and neck surgery

Am J Otolaryngol. 2021 May-Jun;42(3):102876. doi: 10.1016/j.amjoto.2020.102876. Epub 2021 Jan 6.


Purpose: To investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials.

Materials and methods: Pilot prospective study from April 2018-January 2019 at Rush University Medical Center. Glove and instrument washings were collected from 18 high-risk head and neck cancer resection cases (36 samples total). Each case maintained at least one of the following features in addition to a diagnosis of squamous cell carcinoma or sarcoma: palliative/salvage surgery, positive margins, extensive tumor burden, and/or extra capsular extension (ECE). Surgical gloves and four main instruments were placed through washings for blind cytological assessment (2 samples/case).

Results: 18 patients undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned characteristics were included. 26.7% of cases had ECE, 40.0% had positive final margins and 46.7% had close final margins. Tumor locations included: oral cavity (10), neck (4), parotid gland (2), and skin (2). Malignant cells were isolated on glove washings in 1 case (5.5%). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin were isolated from 94.4% of washings. Squamous cells were differentiated from mature cells by the absence of nuclei.

Conclusions: Malignant squamous cells can be isolated from surgical glove washings, supporting the practice of changing of gloves after gross tumor resection during major head and neck cancer resections.

Keywords: Cytology; Head and neck cancer; Quality; Surgical gloves; Surgical instruments; Tumor resection.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / surgery*
  • Cytological Techniques
  • Female
  • Gloves, Surgical / adverse effects*
  • Head and Neck Neoplasms / pathology*
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Male
  • Margins of Excision
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local
  • Neoplasm Seeding*
  • Otorhinolaryngologic Surgical Procedures / adverse effects*
  • Otorhinolaryngologic Surgical Procedures / methods
  • Pilot Projects
  • Prospective Studies
  • Salvage Therapy
  • Sarcoma / pathology*
  • Sarcoma / surgery*
  • Surgical Instruments / adverse effects*