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Negative margin means : no cancerous cells seen beyond line of cutting - it is actually cauterization that they use, not scissors or scalpels. (at least it was case in our surgery)
They cut away from the gland, as much as they can, so - when you look at the slide you see the whole section of a gland (gland is sliced like using egg mandolin on an egg) - one whole horizontal slice at a time. I was lucky in a sense that surgeon arranged us having a zoom call with pathologist and we went over slides together.
Since I am biologist and worked with microscope extensively it was easy for me to follow but my hubby saw things clearly also because pathologist was very patient and very good at showing and explaining findings.
We had one single EPE, that kind of EPE is called unifocal (one focus/ spot). They actually measure EPE size - it's width and also how much it is peeking out of the gland. BEYOND that EPE is a tissue (usually fat tissue) and than there is line - that is line of cutting. Line of cutting is dyed very clearly and in different ways and colors so they can know what is up, left, right, down.
To make the story short - it is very visible where that line passes AROUND the specimen. If it cuts too close to the gland or nicks a gland - it is positive, if the whole gland is intact and than some other tissue is BEFORE the line - it is negative. Negative means - no glandular or cancerous tissue is beyond the excision line.
They do not cut out only the gland, they cut out some fatty tissue around it for examination and also sometimes some nodes.
So - can you have EPE and negative margins - absolutely !!!
It means that line of excision is above and beyond visible EPE. Since we are talking about MICROSCOPIC examination, idea is that even microscopic bad cells would be seen if they are beyond EPE , but of course, one can not 100% examine every single cell in a gland ! That is why EPE is a red flag, no matter if margin is negative. BUT, if it is inside margin, it is a small red flag. If it is unifocal, it is even smaller red flag, if it is 3+3 EPE it is the tiniest "flaglet", etc.
And this goes for every single finding !!! Determination of how adverse situation really is depends of margins, size, gleason , and extent of every adverse feature present.
Replies to "@heavyphil Negative margin means : no cancerous cells seen beyond line of cutting - it is..."
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@surftohealth88 You are bringing me back to my old histology/microbiology days… Such pretty colors for such nasty things!
In my cases the EPE was described as a ‘tiny’ break with negative margins- still needed SRT years later. But my Gleason 4+3 was high volume so I consider myself lucky…could have been a lot worse.
I should not have mixed oranges and apples in my post. What I was referring to are those cases (not simple EPE) in which the cancer extends way beyond the capsule and adipose tissue into the bladder or urethra or bowel. Now the ‘margin’ becomes something else completely.
Many times the surgeon will simply get as much as he can and leave it to the RO/medical Onco to finish the job…but sometimes they DO perform much more extensive removal.
I met a man a few years back who went in for RARP and came out of the OR missing his bladder as well. The PCa had invaded significantly and the surgeon knew that once the muscle layer is invaded, the bladder has to go.
Don’t know if this possibility was discussed beforehand or what diagnostic pre-op scans were done, but the procedure was done at Sloan so I am sure they didn’t go in blindly…
Phil