Start Making Sense: Addressing Reported Ambiguity of Final Margin Status for Oral Cavity Cancer.

Abstract

The surgical pathology report contains vital information guiding postoperative care; however, it often lacks critical details regarding final resection margin status, leaving downstream providers vulnerable to misinterpretation. We sought to quantify the interpretability of our institution's oral cancer surgical pathology reports. Head and neck surgeons, pathologists, medical and radiation oncologists retrospectively reviewed 149 pathology reports. Reviewers classified final margin status in a two-tiered process: first, as "ambiguous" or "unambiguous." Then, unambiguous margin status was classified into negative, positive, or at risk (< 5 mm). Rates of margin status agreement varied significantly across reviewers. Reported ambiguous margin status ranged from 15.4% to 40.9%. Roughly two-thirds of pathology reports were deemed ambiguous by at least one reviewer. Significant margin status ambiguity and low interrater agreement highlight the limitations of current surgical pathology reporting. Standardized reporting practices are needed to improve clarity, enhance multidisciplinary communication, and optimize postoperative care.