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A comparison of microscopic ink characteristics of 35 commercially available surgical margin inks
Milan Milovancev1, Christiane V Löhr, Robert J Bildfell
1Department of Clinical Sciences, Oregon State University, Corvallis, OR.
Objective:
To compare microscopic characteristics of commercially available surgical margin inks used for surgical pathology specimens.
Study Design:
Prospective in vitro study.
Sample Population:
Thirty-five different surgical margin inks (black, blue, green, orange, red, violet, and yellow from 5 different manufacturers).
Methods:
Inks were applied to uniform, single-source, canine cadaveric full-thickness ventral abdominal tissue blocks. Tissue blocks and ink manufacturers were randomly paired and each color was applied to a length of the cut tissue margin. After drying, tissues were fixed in formalin, and 3 radial slices were obtained from each color section and processed for routine histologic evaluation, yielding 105 randomly numbered slides with each manufacturer's color represented in triplicate. Slides were evaluated by 5 blinded, board-certified veterinary anatomic pathologists using a standardized scoring scheme. Statistical analyses were performed to evaluate for ink manufacturer effects on scores, correlation among different subjective variables, and pathologist agreement.
Results:
Black and blue had the most consistently high scores whereas red and violet had the most consistently low overall scores, across all manufacturers. All colors tested, except yellow, had statistically significant differences in overall scores among individual manufacturers. Overall score was significantly correlated to all other subjective microscopic scores evaluated. The average Spearman correlation coefficient among the 10 pairwise pathologists overall ink scores was 0.60.
Conclusions:
There are statistically significant differences in microscopic ink characteristics among manufacturers, with a notable degree of inter-pathologist agreement.
Insights
Microscopic evaluation of surgical margin inks revealed significant differences among manufacturers and colors. Black and blue inks generally performed best, while red and violet had lower scores, indicating variability in ink quality for pathology specimens.
Area of Science:
- Veterinary Pathology
- Surgical Pathology
- Histology
Background:
- Accurate margin assessment is crucial in surgical pathology.
- Surgical margin inks are used to delineate tissue edges.
- Variability in ink performance can impact diagnostic accuracy.
Purpose of the Study:
- To compare the microscopic characteristics of various commercially available surgical margin inks.
- To assess the impact of ink manufacturer and color on histological evaluation.
- To determine the degree of inter-pathologist agreement in assessing ink quality.
Main Methods:
- Prospective in vitro study involving 35 surgical margin inks from 5 manufacturers.
- Inks applied to canine cadaveric tissue, fixed, and processed for routine histology.
- 5 blinded, board-certified veterinary anatomic pathologists evaluated slides using a standardized scoring scheme.
Main Results:
- Black and blue inks received consistently high scores; red and violet inks received consistently low scores.
- Statistically significant differences in overall scores were observed among manufacturers for all colors except yellow.
- Overall ink scores correlated significantly with other subjective microscopic evaluations.
Conclusions:
- Significant variations exist in the microscopic characteristics of surgical margin inks across different manufacturers.
- Inter-pathologist agreement in evaluating ink characteristics was notable.
- These findings highlight the importance of ink selection for reliable surgical pathology assessment.
