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Difference between revisions of "Surgical margins"
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*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]]. | *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]]. | ||
==Positive margin definition== | |||
Unfortunately, there is no universal definition for ''positive margin''. | |||
Definitionally, there is agreement that "tumour touching the edge of the specimen" is a ''positive margin''.<ref name=pmid26028131>{{cite journal |authors=Chagpar AB, Killelea BK, Tsangaris TN, Butler M, Stavris K, Li F, Yao X, Bossuyt V, Harigopal M, Lannin DR, Pusztai L, Horowitz NR |title=A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer |journal=N Engl J Med |volume=373 |issue=6 |pages=503–10 |date=August 2015 |pmid=26028131 |pmc=5584380 |doi=10.1056/NEJMoa1504473 |url=}}</ref><ref name=pmid16509840/> | |||
It may be useful to differentiate ''pathologic margin [status]'' (tumour touching inked margin) and ''oncologic margin [status]'' (tumour sufficiently clear of margin to not significantly affect the prognosis). Oncologists, surgeons and patients really only care about ''oncologic margin [status]'' for relatively obvious reasons. | |||
Perhaps confusing is that: ''a [pathologically] clear margin'' may be defined as being ''[oncologically] a positive margin'', e.g. tumour ''not'' touching the ink of an inked margin - but less than 1 mm from the ink - may be a "positive margin".<ref name=pmid16509840>{{cite journal |authors=Scopa CD, Aroukatos P, Tsamandas AC, Aletra C |title=Evaluation of margin status in lumpectomy specimens and residual breast carcinoma |journal=Breast J |volume=12 |issue=2 |pages=150–3 |date=2006 |pmid=16509840 |doi=10.1111/j.1075-122X.2006.00223.x |url=}}</ref> | |||
==Adequate margin== | ==Adequate margin== | ||
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|- | |- | ||
| [[Colorectal carcinoma]] | | [[Colorectal carcinoma]] | ||
| > | | >1 mm;<ref name=pmid37722286>{{cite journal |authors=Smith HG, Schlesinger NH, Qvortrup C, Chiranth D, Lundon D, Ben-Yaacov A, Caballero C, Suppan I, Kok JH, Holmberg CJ, Mohan H, Montagna G, Santrac N, Sayyed R, Schrage Y, Sgarbura O, Ceelen W, Lorenzon L, Brandl A |title=Variations in the definition and perceived importance of positive resection margins in patients with colorectal cancer - an EYSAC international survey |journal=Eur J Surg Oncol |volume=49 |issue=11 |pages=107072 |date=November 2023 |pmid=37722286 |doi=10.1016/j.ejso.2023.107072 |url=}}</ref> circumferential margin (esp. in rectal carcinoma) most important<ref name=pmid7915774>{{Cite journal | last1 = Adam | first1 = IJ. | last2 = Mohamdee | first2 = MO. | last3 = Martin | first3 = IG. | last4 = Scott | first4 = N. | last5 = Finan | first5 = PJ. | last6 = Johnston | first6 = D. | last7 = Dixon | first7 = MF. | last8 = Quirke | first8 = P. | title = Role of circumferential margin involvement in the local recurrence of rectal cancer. | journal = Lancet | volume = 344 | issue = 8924 | pages = 707-11 | month = Sep | year = 1994 | doi = | PMID = 7915774 }}</ref> | ||
| 1 cm<ref name=pmid18766404>{{Cite journal | last1 = Rutkowski | first1 = A. | last2 = Bujko | first2 = K. | last3 = Nowacki | first3 = MP. | last4 = Chmielik | first4 = E. | last5 = Nasierowska-Guttmejer | first5 = A. | last6 = Wojnar | first6 = A. | title = Distal bowel surgical margin shorter than 1 cm after preoperative radiation for rectal cancer: is it safe? | journal = Ann Surg Oncol | volume = 15 | issue = 11 | pages = 3124-31 | month = Nov | year = 2008 | doi = 10.1245/s10434-008-0125-6 | PMID = 18766404 }}</ref> | | 1 cm<ref name=pmid18766404>{{Cite journal | last1 = Rutkowski | first1 = A. | last2 = Bujko | first2 = K. | last3 = Nowacki | first3 = MP. | last4 = Chmielik | first4 = E. | last5 = Nasierowska-Guttmejer | first5 = A. | last6 = Wojnar | first6 = A. | title = Distal bowel surgical margin shorter than 1 cm after preoperative radiation for rectal cancer: is it safe? | journal = Ann Surg Oncol | volume = 15 | issue = 11 | pages = 3124-31 | month = Nov | year = 2008 | doi = 10.1245/s10434-008-0125-6 | PMID = 18766404 }}</ref> | ||
| [[Gastrointestinal pathology]] | | [[Gastrointestinal pathology]] | ||
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|System --> | |System --> | ||
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==Fragmented and incised specimens== | |||
There is limited advice on how to deal with a fragmented or incised specimen. | |||
If the specimen can be "put back together", it is reasonable to assess the margin and comment on the limitation. | |||
The ''College of American Pathologists'' synoptic for invasive breast carcinoma (version 4.3.0.1) states:<ref>URL: [https://documents.cap.org/protocols/cp-breast-invasive-resection-19-4301.pdf https://documents.cap.org/protocols/cp-breast-invasive-resection-19-4301.pdf]. Accessed on: 2022 January 12.</ref> | |||
:''If the specimen is received sectioned or fragmented, this should be noted, as this will limit the ability to evaluate the status of margins.'' | |||
==Microscopic== | ==Microscopic== | ||