Reliability of Margin Assessment after Surgery for Extremity Soft Tissue Sarcoma: The SSG Experience

Abstract

Surgery remains the mainstay of soft tissue sarcoma (STS) treatment and has been the primary treatment for the majority of patients in Scandinavia during the last 30 years although the use of adjuvant radiotherapy has increased. Patient and treatment characteristics have been recorded in the Scandinavian Sarcoma Group (SSG) Register since 1987. When the effect of new radiotherapy guidelines from 1998 was evaluated, the reliability of surgical margin assessments among different Scandinavian institutions was investigated. Margins were reevaluated by a panel of sarcoma surgeons, studying pathology and surgical reports from 117 patients, randomly selected among 470 recorded patients treated between 1998-2003. In 80% of cases, the panel agreed with the original classification. Disagreement was most frequent when addressing the distinction between marginal and wide margins. Considered the element of judgment inherent in all margin assessment, we find this reliability acceptable for using the Register for studies of local control of STS.

Figure 1

Final agreement among three reviewers with original margin classification. 117 randomly selected cases from four large Scandinavian sarcoma centers, treatment 1998–2003.

Figure 2

A fraction of patients where all reviewers agreed on a different margin than originally reported to the SSG Register relative to the total amount of cases reviewed (n = 117).