0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Early Oral Tongue Squamous Cell Carcinoma Sampling of Margins From Tumor Bed and Worse Local Control

Jessica H. Maxwell, MD, MPH1; Lester D. R. Thompson, MD2; Margaret S. Brandwein-Gensler, MD3,4; Bernhard G. Weiss, MD5; Martin Canis, MD5; Bibianna Purgina, MD6; Arpan V. Prabhu, BS7; Chi Lai, MD6; Yongli Shuai, MS8; William R. Carroll, MD9; Anthony Morlandt, MD, DDS9; Umamaheswar Duvvuri, MD, PhD1,10; Seungwon Kim, MD1; Jonas T. Johnson, MD1; Robert L. Ferris, MD, PhD1; Raja Seethala, MD7; Simion I. Chiosea, MD7
[+] Author Affiliations
1Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
2Department of Pathology, Southern California Permanente Medical Group, Woodland Hills
3Division of Anatomic Pathology, Department of Pathology, The University of Alabama at Birmingham
4Now with the Department of Pathology and Anatomical Sciences, State University of New York at the University at Buffalo and Erie County Medical Center, Buffalo, NY
5Department of Otorhinolaryngology–Head and Neck Surgery, University of Göttingen, Göttingen, Germany
6Department of Pathology and Laboratory Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
7Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
8Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
9Department of Surgery, Head and Neck Oncology, The University of Alabama at Birmingham
10Department of Otolaryngology, Veterans Affairs of Pittsburgh Health System, Pittsburgh, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2015;141(12):1104-1110. doi:10.1001/jamaoto.2015.1351.
Text Size: A A A
Published online

Importance  Positive margins are associated with poor prognosis among patients with oral tongue squamous cell carcinoma (SCC). However, wide variation exists in the margin sampling technique.

Objective  To determine the effect of the margin sampling technique on local recurrence (LR) in patients with stage I or II oral tongue SCC.

Design, Setting, and Participants  A retrospective study was conducted from January 1, 1986, to December 31, 2012, in 5 tertiary care centers following tumor resection and elective neck dissection in 280 patients with pathologic (p)T1-2 pN0 oral tongue SCC. Analysis was conducted from June 1, 2013, to January 20, 2015.

Interventions  In group 1 (n = 119), tumor bed margins were not sampled. In group 2 (n = 61), margins were examined from the glossectomy specimen, found to be positive or suboptimal, and revised with additional tumor bed margins. In group 3 (n = 100), margins were primarily sampled from the tumor bed without preceding examination of the glossectomy specimen. The margin status (both as a binary [positive vs negative] and continuous [distance to the margin in millimeters] variable) and other clinicopathologic parameters were compared across the 3 groups and correlated with LR.

Main Outcomes and Measures  Local recurrence.

Results  Age, sex, pT stage, lymphovascular or perineural invasion, and adjuvant radiation treatment were similar across the 3 groups. The probability of LR-free survival at 3 years was 0.9 and 0.8 in groups 1 and 3, respectively (P = .03). The frequency of positive glossectomy margins was lowest in group 1 (9 of 117 [7.7%]) compared with groups 2 and 3 (28 of 61 [45.9%] and 23 of 95 [24.2%], respectively) (P < .001). Even after excluding cases with positive margins, the median distance to the closest margin was significantly narrower in group 3 (2 mm) compared with group 1 (3 mm) (P = .008). The status (positive vs negative) of margins obtained from the glossectomy specimen correlated with LR (P = .007), while the status of tumor bed margins did not. The status of the tumor bed margin was 24% sensitive (95% CI, 16%-34%) and 92% specific (95% CI, 85%-97%) for detecting a positive glossectomy margin.

Conclusions and Relevance  The margin sampling technique affects local control in patients with oral tongue SCC. Reliance on margin sampling from the tumor bed is associated with worse local control, most likely owing to narrower margin clearance and greater incidence of positive margins. A resection specimen–based margin assessment is recommended.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Schematic Representation of the 3 Workflow Groups

An exophytic tumor at the lateral oral tongue is illustrated. In group 2, white irregular areas represent residual carcinoma at the margin. In groups 2 and 3, colored dots represent tumor bed margins.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Box Plot Distribution of Margin Clearance by Workflow Group

The distance from carcinoma to the closest margin was significantly narrower in group 3 vs group 1 (P = .008). Patients with positive margins were excluded. The horizontal lines indicate the median; the diamonds indicate the mean; and the circles indicate outliers.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Risk of Local Recurrence by Workflow Group

A, Local recurrence and time since procedure, group 1 vs group 2 (P = .06). B, Local recurrence and time since procedure, group 1 vs group 3 (P = .03).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Risk of Local Recurrence by Status (Positive vs Negative) of the Glossectomy Margin

Kaplan-Meier plot of probability and time since procedure.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

2,386 Views
3 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();