%0 Journal Article
%T Reliability of Margin Assessment after Surgery for Extremity Soft Tissue Sarcoma: The SSG Experience
%A Clement S. Trovik
%A Sigmund Skjeldal
%A Henrik Bauer
%A Anders Rydholm
%A Nina Jebsen
%J Sarcoma
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/290698
%X Surgery remains the mainstay of soft tissue sarcoma (STS) treatment and has been the primary treatment for the majority of patients in Scandinavia during the last 30 years although the use of adjuvant radiotherapy has increased. Patient and treatment characteristics have been recorded in the Scandinavian Sarcoma Group (SSG) Register since 1987. When the effect of new radiotherapy guidelines from 1998 was evaluated, the reliability of surgical margin assessments among different Scandinavian institutions was investigated. Margins were reevaluated by a panel of sarcoma surgeons, studying pathology and surgical reports from 117 patients, randomly selected among 470 recorded patients treated between 1998¨C2003. In 80% of cases, the panel agreed with the original classification. Disagreement was most frequent when addressing the distinction between marginal and wide margins. Considered the element of judgment inherent in all margin assessment, we find this reliability acceptable for using the Register for studies of local control of STS. 1. Introduction Soft Tissue Sarcomas (STSs) are optimally removed with a safety margin of healthy tissue encompassing the tumor. After surgery, the completeness of removal is evaluated by assessing the quality and thickness of this margin. During the last decades, the margin has most often been classified as intralesional, marginal, wide, or radical/compartmental referring to Enneking et al. [1]. During the early years (1970s) of the Scandinavian Sarcoma Group¡¯s (SSG) existence, compartmental excisions according to Enneking were sometimes attempted. However, better referral practices, with more patients referred to tumor centers before surgery, has often made it possible to avoid the sacrifice of function such operations entail. Routine use of MRI in planning has enabled safe resection margins inside compartments [2¨C4]. The surgical goal is currently a wide margin with a cuff of healthy tissue surrounding the tumor. For strictly intramuscular tumors, this margin is often obtained by myectomy [5]. It is widely accepted that the quality of the surgical margin is of prime importance for local control [6¨C8]. To compare results from different series and to evaluate other treatment modalities for local control, a strict definition of the margin assessment procedure is needed. Different routines for margin assessment are described [5, 8¨C12]. Most studies report a margin assessed by the surgeon and validated by the pathologist or jointly assessed by the two. In recent years, it has also been more common to report whether the
%U http://www.hindawi.com/journals/sarcoma/2012/290698/