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Comment & Response
June 2018

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

Author Affiliations
  • 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
JAMA Otolaryngol Head Neck Surg. 2018;144(6):542. doi:10.1001/jamaoto.2018.0080

In Reply We appreciate the letter by Dr Duvvuri and colleagues regarding our recent study and the opportunity to further discuss our work. We agree that a lack of standardization in margin assessment in the National Cancer Database (NCDB) is a meaningful limitation. As we mentioned in the Discussion section of our article, variation in what constitutes a positive margin across pathologists and margin harvesting techniques may differ across surgeons and institutions.1 The NCDB likely groups patients with negative margins on the primary specimen and negative margins from repeated resections or tumor bed biopsies together, and we were unable to make these distinctions based on the available data. It is therefore possible that the survival advantage of having high institutional rates of negative margins would be even greater if margin assessment was standardized.