University of Toronto, Department of Surgery, Division of Plastic, Reconstructive, and Aesthetic Surgery, Toronto, Canada.
McMaster University, Department of Pathology and Molecular Medicine, Division of Anatomical Pathology, Hamilton, Canada.
J Plast Reconstr Aesthet Surg. 2024 Oct;97:156-162. doi: 10.1016/j.bjps.2024.07.063. Epub 2024 Jul 30.
Guidelines on clinical margins for basal cell carcinoma (BCC) excisions were recently published, yet the ambiguity regarding the margin continues for surgeons and pathologists. The purpose of this study was to determine the incomplete excision rate of BCC, determine the factors associated with incomplete excision, and evaluate the completeness of reporting between surgeon and pathologist.
A single-center retrospective analysis was conducted on pathology reports from single excisions of BCC specimens between January 1, 2019 to December 31, 2020. The primary outcome was the incomplete excision rate (positive margins) as reported by pathologist. Logistic regression was used to determine the relationship between incomplete excision rate and anatomical location, pathologist, and surgeon. The completeness of surgeon pathology requisition forms was evaluated qualitatively.
Seven hundred and fifty-six pathology reports were included. The incomplete excision rate was 12% (n = 94). The most common site of incomplete excision was head and neck (n = 87, 15%), followed by trunk (n = 5, 7%), and extremities (n = 2, 2%). Five hundred and seventy-nine specimens from 6 surgeons and 9 pathologists were included in the logistic regression analysis. The Wald test showed that the location was significantly associated with incomplete excision (p < 0.05), whereas surgeon and pathologist reports were not (p > 0.05). Regarding missing information, only 47 (6%) pathology reports included "excision" in the requisition form. Four hundred and three (53%) specimens had no clinical history.
The incomplete excision rate found in this study falls within the report range in the literature. Neither surgeon nor pathologist had significant association with incomplete excision. Incomplete excision rate of BCC may be inflated owing to the lack of standardization in requisition form and pathology reporting.
最近发布了基底细胞癌（BCC）切除的临床切缘指南，但外科医生和病理学家对切缘仍存在模糊认识。本研究旨在确定 BCC 不完全切除率，确定与不完全切除相关的因素，并评估外科医生和病理医生报告的完整性。
对 2019 年 1 月 1 日至 2020 年 12 月 31 日期间单次切除 BCC 标本的病理报告进行单中心回顾性分析。主要结局是病理医生报告的不完全切除率（阳性切缘）。使用逻辑回归确定不完全切除率与解剖部位、病理医生和外科医生之间的关系。定性评估外科医生病理申请表格的完整性。
共纳入 756 份病理报告。不完全切除率为 12%（n=94）。最常见的不完全切除部位是头颈部（n=87，15%），其次是躯干（n=5，7%）和四肢（n=2，2%）。纳入 6 名外科医生和 9 名病理医生的 579 份标本进行逻辑回归分析。Wald 检验显示，位置与不完全切除显著相关（p<0.05），而外科医生和病理医生的报告则无显著相关性（p>0.05）。关于缺失信息，仅 47（6%）份病理报告在申请单中包含“切除”。403（53%）份标本无临床病史。
本研究发现的不完全切除率在文献报告范围内。外科医生和病理医生与不完全切除均无显著相关性。由于申请单和病理报告缺乏标准化，BCC 的不完全切除率可能会被夸大。
