BACKGROUND
Although en bloc resection remains the standard of care for the primary treatment of oral cavity squamous cell carcinomas (OCSCC), methods of intra-operative assessment of margins vary. Two commonly used methods are the sampling of margins from (a) the tumor bed or (b) the main specimen. In tumor bed sampling, the specimen is placed in formalin, and the surgeon harvests margin samples from the tumor bed for intra-operative pathology. If these samples are positive for malignancy, additional tissue is taken from the patient’s tumor bed. In main specimen sampling, tissue sampled from the periphery of the resected specimen undergoes intra-operative pathologic assessment. If positive, additional tissue is resected from the patient’s tumor bed. In this review, we highlight the evidence evaluating methods of intra-operative margin assessment and the correlation between margin assessment methods and patient outcomes.
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October 2024BEST PRACTICE
Although there is conflicting evidence regarding the correlation between margin site and local recurrence (LR) or overall survival (OS) as well as the benefit of margin re-resection, all reviewed studies demonstrate that margin procurement from the main specimen leads to a reduction of final margin positivity rates as compared to margins obtained from the tumor bed. All studies presented agree that final margin positivity is associated with decreased LR control and reduced OS. Some data show that the specimen-directed approach leads to decreased escalation of care as well as decreased healthcare costs. This provides evidence in favor of sampling margins from the specimen as opposed to the tumor bed.