title: Early Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Maxwell
authors.affiliation: Department of Pathology, Southern California Permanente Medical Group, Woodland Hills.
authors.forename: Lester D R
authors.initials: LD
authors.lastname: Thompson
authors.affiliation: Division of Anatomic Pathology, Department of Pathology, The University of Alabama at Birmingham4Now with the Department of Pathology and Anatomical Sciences, State University of New York at the University at Buffalo and Erie County Medical Center, Buffal.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Brandwein-Gensler
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Göttingen, Göttingen, Germany.
authors.forename: Bernhard G
authors.initials: BG
authors.lastname: Weiss
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Göttingen, Göttingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Canis
authors.affiliation: Department of Pathology and Laboratory Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Bibianna
authors.initials: B
authors.lastname: Purgina
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Arpan V
authors.initials: AV
authors.lastname: Prabhu
authors.affiliation: Department of Pathology and Laboratory Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Chi
authors.initials: C
authors.lastname: Lai
authors.affiliation: Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Yongli
authors.initials: Y
authors.lastname: Shuai
authors.affiliation: Department of Surgery, Head and Neck Oncology, The University of Alabama at Birmingham.
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.affiliation: Department of Surgery, Head and Neck Oncology, The University of Alabama at Birmingham.
authors.forename: Anthony
authors.initials: A
authors.lastname: Morlandt
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania10Department of Otolaryngology, Veterans Affairs of Pittsburgh Health System, Pittsburgh, Pennsylvania.
authors.forename: Umamaheswar
authors.initials: U
authors.lastname: Duvvuri
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Seungwon
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Raja
authors.initials: R
authors.lastname: Seethala
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Simion I
authors.initials: SI
authors.lastname: Chiosea
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005927:Glossectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D014062:Tongue Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome