Pathologists lead the standardization of specimen marking to ensure the highest quality of analysis for all cancer patients.
In cancer surgery, the single most important predictor of local recurrence is the tissue margins.1,2 Research indicates that using suture for specimen orientation can result in a 31% disagreement rate between the surgeon and pathologist with regard to margin interpretation.3 For specimens <20cm3, the discordance rate can be as high as 78%.3 Re-excision rates exceed 20% in breast surgery suggesting that some re-excisions
may be performed on the wrong margin.4
MarginMarker™ sterile ink kit and CorrectClips™ radiographic markers remove inconsistencies, reducing error and ambiguity. The pathology lab receives specimens with margins accurately and uniformly marked.
Pathology receives specimens marked with a consistent color coding scheme which completely defines each of the six tissue margins. Entire surface areas are indicated, and irregularities and fissures on the surface are clearly marked in relation to each margin.
Validity of Markings
- MarginMarker sterile inks define the edges of specimen margins; this is more complete than suture, which marks only one point to represent the entire margin plane, and which requires the pathologist to estimate margin boundaries.
- Specimen markings by MarginMarker have greater validity than suture methods. CorrectClips detach easily with minimal interruption to tissue surface compared to suture. False positives can be reduced, as MarginMarker inks minimize migration into crevasses or punctures created by suture.
- Pathologists have greater confidence that if re-excision is required, it is valid and necessary to prevent cancer recurrence, and that the designated margin for re-excision is correct.
Performance of MarginMarker Inks
- MarginMarker sterile inks adhere throughout specimen processing; the colors show brightly on slides, easily distinguishing each margin. There is no need to apply additional ink.
- MarginMarker sterile inks can be used when specimen sterility is maintained for cytogenetic analysis or microbiology testing.
- MarginMarker sterile inks are packaged for single use, minimizing the risk of cross-contamination from other specimens.
Vector Surgical’s tissue margin marking system, comprised of MarginMarker and CorrectClips, provides a secure, complete and accurate designation of tissue specimen margins, potentially contributing to:
Improved Patient Outcomes
- More accurate re-excisions5,6
- Fewer unnecessary re-excisions5,7,8
- Lower cancer recurrence1,9
- Improved cosmesis6,8
- Promotes clear, systematic pathologist-surgeon communication
- MarginMarker and CorrectClips are in compliance with 2012 CAP Accreditation Guidelines for specimen handling by maintaining margin designation during fixation10
- Gage, I.; Schnitt, S.J.; Nixon, A.J.; Silver, B.; Recht, A.; Troyan, S.L.; Eberlein, T.; Love, S.M.; Gelman, R.; Harris, J.R.; and Connolly, J.L. “Pathologic Margin Involvement and the Risk of Recurrence in Patients Treated with Breast-Conserving Therapy.” Cancer 78.9 (1996): 1921-1928.
- MacDonald, H.R.; Silverstein, M.J.; Mabry, H.; Moorthy, B.; Ye, W.; Epstein, M.S.; Holmes, D.; Silberman, H.; and Lagios, M. “Local Control in Ductal Carcinoma In Situ Treated by Excision Alone: Incremental Benefit of Larger Margins.” American Journal of Surgery 190.4 (2005): 521-525.
- Britton, P.D.; Sonoda, L.I.; Yamamoto, A.K.; Koo, B.; Soh, E.; and Goud, A. “Breast Surgical Specimen Radiographs: How Reliable Are They?” European Journal of Radiology 79 (2011): 245-249.
- Molina, M.A.; Snell, S.; Franceschi, D.; Jorda, M.; Gomez, C.; Moffat, F.L.; Powell, J.; and Avisar, E. “Breast Specimen Orientation.” Annals of Surgical Oncology 16 (2009): 285-288.
- McCahill, L.E.; Single, R.M.; Aiello Bowles, E.J.; Feigelson, H.S.; James, T.A.; Barney, T.; Engel, J.M.; and Onitilo, A.A. “Variability in Reexcision Following Breast Conservation Surgery.” Journal of the American Medical Association 307.5 (2012): 467-475.
- Singh, M.; Singh, G.; Hogan, K.T.; Atkins, K.A.; and Schroen, A.T. “The Effect of Intraoperative Specimen Inking on Lumpectomy Re-excision Rates.” World Journal of Surgical Oncology 8.4 (2010).
- Gibson, G.R.; Lesnikoski, B.A.; Yoo, J.; Mott, L.A.; Cady, B.; and Barth, R.J. Jr. “A Comparison of Ink-Directed and Traditional Whole-Cavity Re-Excision for Breast Lumpectomy Specimens with Positive Margins.” Annals of Surgical Oncology 8.9 (2001): 693-704.
- Dooley, W.C. and Parker, J. “Understanding the Mechanisms Creating False Positive Lumpectomy Margins.” American Journal of Surgery 190 (2005): 606-608.
- Landercasper, J., Attai, D., Atisha, D., Beitsch, P., Bosserman, L., Boughey, J., Carter, J., Edge, S., Feldman, S., Froman, J. and Greenberg, C. “Toolbox to reduce lumpectomy reoperations and improve cosmetic outcome in breast cancer patients: The American Society of Breast Surgeons Consensus Conference.” Annals of Surgical Oncology 22.10 (2015): 3174-3183.
- Menes, T.S.; Tartter, P.I.; Bleiweiss, I.; Godbold, J.H.; Estabrook, A.; and Smith, S.R. “The Consequence of Multiple Re-excisions to Obtain Clear Lumpectomy Margins in Breast Cancer Patients.”Annals of Surgical Oncology 12.11 (2005): 881-885.
- “Anatomic Pathology Checklist – Predictive Markers.” College of American Pathologists’ CAP Accreditation Program. ANP. 22998. July 11, 2011.
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