The Head And Neck Oncology Specimen: The Gross Examination As An Essential Component To Diagnosis And Optimal Patient Outcomes

Achieving complete resection in head and neck oncologic cancer surgeries without leaving behind residual disease is the most significant factor to minimize the risk of locoregional recurrence and overall survival. Approaches regarding how to handle en bloc specimens for margin assessment also impact patients' long-term outcomes. Although sampling the tumor bed to evaluate for residual tumor at surgical margins (excision edges) is the most commonly practiced technique, some studies have shown that separately submitted tumor bed margins have lower sensitivity for tumor assessment compared with detection of those positive margins from direct sampling of the en bloc specimen. Close collaboration between the surgeon and pathologist is fundamental to optimize surgical margin assessment and reporting. Current American Joint Committee on Cancer (eighth edition) and National Comprehensive Cancer Network guidelines recommend the en bloc specimen sampling for intraoperative assessment of surgical margins. Cutoffs less than 5 mm between tumor and the surgical margin had been considered adequate in specific subsites in head and neck region. Emerging in situ imaging modalities and molecular testing may help to reduce inadequate surgical margins during tumor resections; however, further studies and validation are needed. This article presents a review of recent publications and guidelines of general grossing principles and recent updates to optimize cancer-free surgical margins and to emphasize the limitation issues encountered in routine practice.