04-11-2025
- Op Text: 04-11-2025 Laparoscopic, robotic radical prostatectomy. Bilateral pelvic lymph node dissection (Hospital ABC): Findings: Visible tumor on the right lateral prostate near the mid gland towards the apex. No evidence of gross extraprostatic extension. Uneventful radical robotic prostatectomy with bilateral pelvic lymph node dissection and urethral suspension.
- Gross section of the path report: The prostate is serially sectioned from apex to base to demonstrate approximately 1.3 x 1.1 x 0.8 cm, bright white – tan, soft, suspicious area within the posterior right aspect, which appears grossly confined to the prostate.
- Margin Status from the Synoptic Portion of the Path
- Margin Status: Focally positive at right apex, less than 3 mm
Question: How will you assign Surgical Margins of the Primary Site?
- 1 Residual tumor, NOS
- 2 Microscopic residual tumor
- 3 Macroscopic residual tumor
Answer: 2 Microscopic residual tumor
Rationale: SEER Instructions below/ STORE supports this as well.
- Assign code 2 for involvement of margins microscopically but not grossly (cannot be seen by
the naked eye). Use the Margins section of the CAP protocol or the Microscopic Description
from the pathology report to identify microscopic findings.
- Assign code 3 for involvement of margins grossly (seen by the naked eye). Use the Margins
section of the CAP protocol or the Gross Description from the pathology report to identify
macroscopic findings.
Discussion: We see far too often registrars just default to a 1 if the margins are positive, instead of reviewing and assigning the more specific codes. Most of the time you can differentiate if the margins were either microscopic (not visible by the naked eye) or macroscopic (visible to the naked eye). Do a little QA in your registry, how many 1’s do you see?
