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Scientific Oral Presentation

Head and Neck Surgery

Surgeon-pathologist Concordance in Head and Neck Specimen Orientation and Margin Sampling

Saturday, October 17, 2026
9:42 AM - 9:48 AM PT
Location: West Exhibit Hall A, Learning Zone 3

    Presenting Author(s)

  • Andreja Radevic, BS

    Head and Neck Surgery Research Fellow
    Vanderbilt University Medical Center
    New York, NY, United States

    • Co-Author(s)

  • jA

    joaquin Austerlitz, BS

    Head and Neck Surgery Research Fellow
    Vanderbilt University Medical Center, United States

  • Sindhura Sridhar, BS

    Medical Student
    Texas A&M University College of Medicine
    Austin, TX, United States

  • Whitney Jin, BA

    Medical Student
    Baylor College of Medicine
    Houston, TX, United States

    • Senior Author(s)

  • Michael C. Topf, MD MSCI

    Associate Professor
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

Disclosure(s):
Andreja Radevic, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Accurate intraoperative specimen orientation and margin sampling are critical in head and neck surgical oncology, but complex specimen anatomy may lead to miscommunication between surgeons and pathologists. This study evaluates the concordance between surgeons and pathology teams in specimen orientation and margin sampling.

Methods: In this ongoing prospective observational study, surgeons oriented resected head and neck tumor specimens using one or two sutures to denote laterality (e.g., superior, anterior) and identified potential margin sampling sites using a specimen-based approach per standard of care. Independently, pathologists or pathologist assistants oriented the same specimens and identified margins for sampling. Orientation accuracy and concordance of margin sampling sites (defined as ≤5 mm apart) were recorded.

Results: Sixty-four resected head and neck specimens have been analyzed to date (mean size 5.0 cm, SD 2.5). Anatomic subsites include oral cavity (n=21), oropharynx (n=16), skin (n=16), nasal cavity/paranasal sinuses (n=7), and parotid (n=4). Pathologists correctly oriented 56 specimens (87.5%) and misoriented 8 (12.5%), most of which had one orientation stitch (n=7). The 8 incorrectly oriented cases included parotid (n=2), nasal cavity/paranasal sinuses (n=2), skin (n=2), oral cavity (n=1), and oropharynx (n=1) cases. Among 23 cases assessed for specimen-based margin analysis, surgeons submitted 1.83 margins/case (total 42) versus 2.04 (total 47) for pathologists (p = 0.13). Among cases where both surgeons and pathologists sent margins (n=13, 36 total margins), concordant sampling occurred in 22 instances (61.1%), while discordance occurred in 14 instances (38.9%).

Conclusions: Misorientation and disagreement in margin sampling sites are common in head and neck resection specimens. These discrepancies highlight critical communication gaps between surgeons and pathologists and opportunities for improvement.