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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>{{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> | |||
It may be useful to differentiate ''pathologic margin'' (tumour touching ink) and ''oncologic margin'' (tumour sufficiently clear of margin to not affect the prognosis). Oncologists, surgeons and patients really only care about ''oncologic margin'' for relatively obvious reasons. | |||
Perhaps confusing is that: ''[pathologically] clear margins'' are defined to be ''positive margin''.<ref>{{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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==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== | ||