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Comment & Response
June 2018

Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure

Author Affiliations
  • 1Department of Otolaryngology, Veterans Affairs of Pittsburgh Health System, Pittsburgh, Pennsylvania
  • 2Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 3Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2018;144(6):541-542. doi:10.1001/jamaoto.2018.0074

To the Editor The study by Schoppy et al1 provides information that furthers the dialogue about how surgical margins are assessed, both intraoperatively and on formalin-fixed specimens, and offers a seemingly attractive and clinically meaningful quality measure in head and neck surgery: a negative margin rate of 90%. The authors appropriately note a major limitation of this study—variation in margin sampling techniques across surgeons. By design, the authors could not define the source of negative margin: was margin status deduced from the actual resection specimen or tumor bed biopsies? How is the adequacy of margin revision determined?2,3 This limitation makes the proposed metric of a “90% or higher negative margin” rate a nonactionable one.

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