Perhaps margins are not necessarily a reflection of surgical adequacy, like we use them, but more a reflection of the biology of the disease.— Allen Cheng, MD, DDS
The study findings by Dr. Buchakjian and colleagues suggest it may be time to revisit the significance of frozen margin status, according to one of the session co-moderators, Allen Cheng, MD, DDS, of the Providence Cancer Center and Head & Neck Surgical Associates, both in Portland, Oregon.
“Perhaps margins are not necessarily a reflection of surgical adequacy, like we use them, but more a reflection of the biology of the disease. Perhaps that’s why even though you go back and take out more [disease], it doesn’t matter,” he commented in an interview. “I think the real questions are maybe, do we even need to do it, and is it really just a matter of the biology rather than did we do enough surgery?”
That said, discontinuing margin assessment would be difficult “because it’s an outcome measure that we follow,” Dr. Cheng added. “It’s a quality metric, just like the number of lymph nodes removed in a neck dissection is a metric that a lot of people follow.”
Susan D. McCammon, MD
“It is very hard to talk people out of taking margins,” agreed the other session co-moderator, Susan D. McCammon, MD, of the Department of Otolaryngology, University of Texas Medical Branch at Galveston.
“There’s quite a lot of research on noninvasive ways of assessing oral malignant and premalignant lesions—optical coherence tomography, multiphoton autofluorescence microscopy and second harmonic generation microscopy are imaging techniques that may allow us to see cancer in vivo better. We hope combinations of such techniques may better define margin assessment, but they are still in development,” said Dr. McCammon. ■
Disclosure: Drs. Cheng and McCammon reported no potential conflicts of interest.
We concluded that the main specimen margin is significantly associated with local recurrence and is the strongest predictor of recurrence compared to the tumor bed frozen margins and the final operative margin.— Marisa R. Buchakjian, MD, PhD