48,436
edits
Difference between revisions of "Surgical margins"
Jump to navigation
Jump to search
→Types of margins: fix sp
(→Types of margins: fix sp) |
|||
| (6 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
[[Image:Urothelial_carcinoma_positive_margin_-_alt_--_high_mag.jpg|thumb|right|200px|A positive surgical margin (ink on tumour) in [[urothelial carcinoma]]. [[H&E stain]].]] | [[Image:Urothelial_carcinoma_positive_margin_-_alt_--_high_mag.jpg|thumb|right|200px|A positive surgical margin ([[ink]] on tumour) in [[urothelial carcinoma]]. [[H&E stain]].]] | ||
[[Image:Positive_margin_with_cautery_artefact_-_adenocarcinoma_-_high_mag.jpg|right|thumb|200px|A positive surgical margin (tumour with [[cautery artifact]]) in [[colorectal carcinoma]]. [[H&E stain]].]] | [[Image:Positive_margin_with_cautery_artefact_-_adenocarcinoma_-_high_mag.jpg|right|thumb|200px|A positive surgical margin (tumour with [[cautery artifact]]) in [[colorectal carcinoma]]. [[H&E stain]].]] | ||
The '''surgical margins''', often simply referred to as '''margins''', are the set of surfaces that were cut by the surgeon in order to remove the specimen from the body. The distance between the tumour and the margin is called the '''surgical clearance''', a term that may be used interchangeably with the term ''surgical margin''.<ref name=pmid8443747>{{Cite journal | last1 = Ng | first1 = IO. | last2 = Luk | first2 = IS. | last3 = Yuen | first3 = ST. | last4 = Lau | first4 = PW. | last5 = Pritchett | first5 = CJ. | last6 = Ng | first6 = M. | last7 = Poon | first7 = GP. | last8 = Ho | first8 = J. | title = Surgical lateral clearance in resected rectal carcinomas. A multivariate analysis of clinicopathologic features. | journal = Cancer | volume = 71 | issue = 6 | pages = 1972-6 | month = Mar | year = 1993 | doi = | PMID = 8443747 }}</ref> Margins are important as an incompletely removed disease process may lead to re-occurrence. | The '''surgical margins''', often simply referred to as '''margins''', are the set of surfaces that were cut by the surgeon in order to remove the specimen from the body. The distance between the tumour and the margin is called the '''surgical clearance''', a term that may be used interchangeably with the term ''surgical margin''.<ref name=pmid8443747>{{Cite journal | last1 = Ng | first1 = IO. | last2 = Luk | first2 = IS. | last3 = Yuen | first3 = ST. | last4 = Lau | first4 = PW. | last5 = Pritchett | first5 = CJ. | last6 = Ng | first6 = M. | last7 = Poon | first7 = GP. | last8 = Ho | first8 = J. | title = Surgical lateral clearance in resected rectal carcinomas. A multivariate analysis of clinicopathologic features. | journal = Cancer | volume = 71 | issue = 6 | pages = 1972-6 | month = Mar | year = 1993 | doi = | PMID = 8443747 }}</ref> Margins are important as an incompletely removed disease process may lead to re-occurrence. | ||
| Line 14: | Line 14: | ||
**Sample a subset of the surface. | **Sample a subset of the surface. | ||
**The distance between the margin and lesion can be measured at microscopy, i.e. on the glass slide. | **The distance between the margin and lesion can be measured at microscopy, i.e. on the glass slide. | ||
Note: | |||
*It should ''always'' be clear from the ''[[Principles of grossing|gross description]]'' which type of margin was taken; this is especially important for cases that were not [[submitted in total]]. | |||
==Adequate margin== | ==Adequate margin== | ||
| Line 44: | Line 47: | ||
|- | |- | ||
| [[Ductal carcinoma in situ]] | | [[Ductal carcinoma in situ]] | ||
| | | [[ink]] cannot be on tumour - consensus of Society of Surgical Oncology-American Society for Radiation Oncology (for low stage tumours)<ref name=pmid24521674>{{Cite journal | last1 = Moran | first1 = MS. | last2 = Schnitt | first2 = SJ. | last3 = Giuliano | first3 = AE. | last4 = Harris | first4 = JR. | last5 = Khan | first5 = SA. | last6 = Horton | first6 = J. | last7 = Klimberg | first7 = S. | last8 = Chavez-MacGregor | first8 = M. | last9 = Freedman | first9 = G. | title = Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. | journal = Int J Radiat Oncol Biol Phys | volume = 88 | issue = 3 | pages = 553-64 | month = Mar | year = 2014 | doi = 10.1016/j.ijrobp.2013.11.012 | PMID = 24521674 }}</ref> | ||
| | | | ||
| [[Breast pathology]] | | [[Breast pathology]] | ||
|- | |- | ||
| [[Invasive breast cancer|Invasive breast carcinoma]] | | [[Invasive breast cancer|Invasive breast carcinoma]] | ||
| ink cannot be on tumour - consensus of Society of Surgical Oncology-American Society for Radiation Oncology (for low stage tumours) | | ink cannot be on tumour - consensus of Society of Surgical Oncology-American Society for Radiation Oncology (for low stage tumours)<ref name=pmid24521674>{{Cite journal | last1 = Moran | first1 = MS. | last2 = Schnitt | first2 = SJ. | last3 = Giuliano | first3 = AE. | last4 = Harris | first4 = JR. | last5 = Khan | first5 = SA. | last6 = Horton | first6 = J. | last7 = Klimberg | first7 = S. | last8 = Chavez-MacGregor | first8 = M. | last9 = Freedman | first9 = G. | title = Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. | journal = Int J Radiat Oncol Biol Phys | volume = 88 | issue = 3 | pages = 553-64 | month = Mar | year = 2014 | doi = 10.1016/j.ijrobp.2013.11.012 | PMID = 24521674 }}</ref> | ||
| | | | ||
| [[Breast pathology]] | | [[Breast pathology]] | ||
| Line 105: | Line 108: | ||
represent stray ink, as the quantity of ink is minimal; however, margin | represent stray ink, as the quantity of ink is minimal; however, margin | ||
positivity cannot be completely excluded. | positivity cannot be completely excluded. | ||
</pre> | |||
===A re-excised (previously) positive margin is negative for tumour=== | |||
It occasionally happens that a re-excised margin specimen is negative for tumour. | |||
<pre> | |||
The lack of tumour in Part B may be explained by either of the following: | |||
(1) There was minimal clearance (<1 mm) in Part A that was not sampled. | |||
(2) The sampling of Part B missed minimal tumour involvement. | |||
</pre> | |||
Note: | |||
*One should review the positive margin call to ensure it isn't an overall. | |||
===Tumour in tip - flipped block=== | |||
<pre> | |||
Lesion, Right Lower Eyelid, Excision: | |||
- BASAL CELL CARCINOMA (BCC), favour positive margin, see comment. | |||
Comment: | |||
BCC was found in block 1 (one of the tips) on the initial cut. | |||
In block 1, BCC is present but distant from the inked margin in the plane | |||
of section. The margin is not completely in the plane of section; thus, | |||
trimming of a negative margin cannot be entirely excluded. As BCC is seen | |||
on both sides of the block, a positive margin is favoured. | |||
</pre> | </pre> | ||
| Line 111: | Line 138: | ||
*[[Frozen section]]. | *[[Frozen section]]. | ||
*[[Crush artifact]]. | *[[Crush artifact]]. | ||
*[[Marking ink]]. | |||
==References== | ==References== | ||