Schnebelen Alicia M, Gardner Jerad M, Shalin Sara C
From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock.
Arch Pathol Lab Med. 2016 Jul;140(7):678-81. doi: 10.5858/arpa.2015-0313-OA. Epub 2016 Apr 26.
-The practice of reporting margin status in biopsies is relatively unique to biopsies of the skin and highly variable among pathologists.
-To address the accuracy of margin evaluation in shave biopsies of nonmelanoma skin cancers.
-We collected shave biopsies of squamous and basal cell carcinomas that appeared to have uninvolved margins on routine sign out. We obtained deeper levels on corresponding tissue blocks until blocks were exhausted and examined them for tumor at biopsy margins.
-Forty-seven consecutive cases were collected, including 20 squamous cell (43%) and 27 basal cell (57%) carcinomas. Eleven of 47 cases (23%) with negative margins at initial diagnosis demonstrated positive margins upon deeper-level examination. Margins of 8 of 27 basal cell carcinomas (30%) and 3 of 20 squamous cell carcinomas (15%) were erroneously classified as "negative" on routine examination.
-No guidelines exist regarding the reporting of margins in nonmelanoma skin cancer biopsies, and reporting practices vary extensively among pathologists. We found that nearly one-quarter of positive margins in shave biopsies for cutaneous carcinomas are missed on standard histologic examination. Moreover, reporting of a positive margin may also be misleading if the clinician has definitively treated the skin cancer at the time of biopsy. For these reasons, and as routine exhaustion of all tissue blocks is impractical, the decision to include or exclude a comment regarding the margin status should be given conscious consideration, accounting for the clinical intent of the biopsy and any known information regarding postbiopsy treatment.
-在活检中报告切缘状态的做法在皮肤活检中相对独特，并且在病理学家之间差异很大。
-探讨非黑色素瘤皮肤癌刮除活检中切缘评估的准确性。
-我们收集了鳞状细胞癌和基底细胞癌的刮除活检标本，这些标本在常规报告时切缘看似未受累。我们在相应的组织块上获取更深层次的切片，直到组织块用尽，并检查活检切缘处有无肿瘤。
-连续收集了47例病例，包括20例鳞状细胞癌（43%）和27例基底细胞癌（57%）。47例初诊切缘阴性的病例中有11例（23%）在更深层次检查时显示切缘阳性。27例基底细胞癌中有8例（30%）和20例鳞状细胞癌中有3例（15%）的切缘在常规检查中被错误分类为“阴性”。
-目前尚无关于非黑色素瘤皮肤癌活检切缘报告的指南，病理学家之间的报告做法差异很大。我们发现，皮肤癌刮除活检中近四分之一的阳性切缘在标准组织学检查中被漏诊。此外，如果临床医生在活检时已明确治疗了皮肤癌，报告阳性切缘也可能产生误导。出于这些原因，并且由于常规用尽所有组织块不切实际，在决定是否包含关于切缘状态的注释时应慎重考虑，要考虑活检的临床意图以及任何关于活检后治疗的已知信息。
