- RCPA 建议：结直肠原发腺癌切除标本，肉眼肿瘤距纵向切缘（近端、远端）30 mm 以内时才需镜检纵向切缘，除非有侵袭性特征。
- 悉尼 Royal Prince Alfred Hospital 审计 2023-07 至 2025-06 多学科会议病例 308 例：全部常规取纵向切缘，仅 2.27%（7 例）切缘切片有发现（肿瘤性 5 例、非肿瘤性 2 例）；2 例腺癌肉眼即已识别，镜检未改变切缘状态。
- 澳大拉西亚消化病理学会 82 名成员问卷：89% 常规普遍取纵向切缘、91% 取吻合圈；多数认为常规镜检切缘很少提供诊断信息（纵向切缘 91%，吻合圈 68%）。
- 作者主张有针对性的选择性取材，可在不影响患者诊疗的前提下降低成本、工作量与环境影响——对科室取材规范与质控有直接参考价值。
收录范围：PubMed 英文摘要及中文翻译（abstract-only）。原文为订阅制（ScienceDirect，Unpaywall 显示 closed），未采集全文、图表。
摘要
原发性腺癌结直肠切除标本的组织病理学评估中，有两类主要切缘：非腹膜被覆切缘和纵向切缘（近端与远端）。澳大拉西亚皇家病理学院（RCPA）建议，仅当肿瘤肉眼距纵向切缘 30 mm 以内时才对纵向切缘进行镜下检查，除非存在侵袭性特征。我们通过审计 Royal Prince Alfred Hospital（RPAH）多学科会议（2023 年 7 月至 2025 年 6 月）上讨论的结直肠切除标本，并对澳大拉西亚消化病理学会（AGPS）成员的取材实践进行问卷调查，评估了纵向切缘镜下评估的效用。共纳入 308 例标本，全部进行了常规纵向切缘取材。2.27%（n=7）的切缘切片有阳性发现，包括 5 例肿瘤性和 2 例非肿瘤性异常。肿瘤性发现包括腺癌（n=2）、无蒂锯齿状病变（n=1）、低级别异型增生（n=1）和 Paget 病（n=1）。2 例腺癌均已在肉眼检查时识别，镜检并未改变切缘状态。问卷调查共有 82 名参与者；89% 报告常规对所有病例取纵向切缘，91% 常规取吻合圈（donut）。多数参与者认为，常规镜检切缘很少能提供诊断信息（纵向切缘 91%；吻合圈 68%）。有针对性的选择性取材方法可在不影响患者诊疗的前提下降低成本、工作量和环境影响。
- RCPA recommends microscopic examination of longitudinal (proximal and distal) margins of colorectal adenocarcinoma resections only if tumour extends within 30 mm macroscopically, unless aggressive features are present.
- Audit of 308 resections presented at Royal Prince Alfred Hospital MDMs (July 2023 – June 2025): all had routine longitudinal margin sampling; findings in only 2.27% (n=7) of margin sections (5 neoplastic, 2 non-neoplastic); both adenocarcinomas were identified macroscopically and microscopy did not alter margin status.
- Survey of 82 AGPS members: 89% routinely sample longitudinal margins and 91% donuts; most believe routine microscopy of margins rarely yields diagnostic information (91% longitudinal margins; 68% donuts).
- A targeted, selective sampling approach could reduce costs, workload and environmental impact without compromising patient care.
Scope: PubMed abstract only. The article is subscription-only (ScienceDirect; Unpaywall: closed), so full text, figures and tables were not collected.
Abstract
There are two main margins in histopathological assessment of colorectal resections for primary adenocarcinoma: non-peritonealised and longitudinal margins (proximal and distal). The Royal College of Pathologists of Australasia (RCPA) recommends microscopic examination of longitudinal margins only if tumour extends within 30 mm macroscopically, unless aggressive features are present. We evaluated the utility of microscopic longitudinal margin assessment by auditing colorectal resections presented at the Royal Prince Alfred Hospital (RPAH) multidisciplinary meetings (between July 2023 and June 2025) and surveying Australasian Gastrointestinal Pathology Society (AGPS) members on sampling practices. A total of 308 specimens were identified, of which all underwent routine longitudinal margin sampling. Findings were present in 2.27% (n=7) of margin sections, including five neoplastic and two non-neoplastic abnormalities. Neoplastic findings included adenocarcinoma (n=2), sessile serrated lesion (n=1), low-grade dysplasia (n=1), and Paget disease (n=1). Both adenocarcinomas were macroscopically identified and margin status was not altered by microscopy. Regarding the survey, there were 82 participants; 89% reported routine universal longitudinal margin sampling and 91% donut sampling. Most participants believed routine microscopic examination of margins rarely yields diagnostic information (91% for longitudinal margins; 68% for donuts). A targeted approach to selective sampling could reduce costs, workload, and environmental impact without compromising patient care.