Pilot study of intraoperative digital imaging with the use of a mammograph for assessment of bone surgical margins in the head and neck region (original) (raw)
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Assessment of Resection Margins in Bone Tumor Surgery
Sarcoma, 2020
Limb salvage surgery is now the preferred procedure for bone tumor surgery. To decrease the risk of local recurrence, it is crucial to obtain adequate resection margins. The obtained margins must be evaluated postoperatively because they influence what treatment is given subsequently when margins are not adequate (e.g., surgical revision and radiotherapy). The study aims to evaluate margin assessment of tumor specimen by MRI compared to conventional histology (to establish the viability of using MRI) and assess the accuracy of a patient-specific instrument when narrow margins were aimed. The resection margins in 12 consecutive patients that were operated on for bone tumor resection were prospectively analyzed using three methods: MRI of the resection specimen, macroscopic evaluation of specimen slices, and microscopic pathological evaluation. The assessments were qualitative (R0, R1, and R2) and quantitative (distance in mm). MRI, macroscopic, and microscopic margins generated simil...
MRI evaluation of resection margins in bone tumour surgery
2014
In 12 patients operated on for bone sarcoma resection, a postoperative magnetic resonance imaging of the resection specimens was obtained in order to assess the surgical margins. Margins were classified according to MRI in R0, R1, and R2 by three independent observers: a radiologist and two orthopaedic surgeons. Final margin evaluation (R0, R1, and R2) was assessed by a confirmed pathologist. Agreement for margin evaluation between the pathologist and the radiologist was perfect ( = 1). Agreement between the pathologist and an experienced orthopaedic surgeon was very good while it was fair between the pathologist and a junior orthopaedic surgeon. MRI should be considered as a tool to give quick information about the adequacy of margins and to help the pathologist to focus on doubtful areas and to spare time in specimen analysis. But it may not replace the pathological evaluation that gives additional information about tumor necrosis. This study shows that MRI extemporaneous analysis of a resection specimen may be efficient in bone tumor oncologic surgery, if made by an experienced radiologist with perfect agreement with the pathologist.
Clinical Radiology, 2019
To evaluate the accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) in assessing the resection margins of primary malignant bone tumours. MATERIALS AND METHODS: Resected primary malignant bone tumour specimens removed from 46 patients (27 male; mean age: 48AE22 years) were imaged using MRI (fat-saturated proton density-weighted and three-dimensional fat-suppressed T1-weighted gradientrecalled-echo) and CT immediately after surgery. A radiologist and an orthopaedist evaluated bone and soft-tissue margins of the specimens on both examinations. Histological evaluation was performed by a senior orthopaedic oncology pathologist. Margins were classified as R0 (safe margins), R1 (residuals between 0 and 1 mm), and R2 (macroscopic residuals). Cohen's k, chi-square, and McNemar's statistics were used. RESULTS: Having histology as the reference standard, reproducibility of the radiologist ranged from moderate (k¼0.544) to substantial (k¼0.741) for bone and soft-tissue margins on CT, respectively, while that of the orthopaedist ranged from fair (k¼0.316) to moderate (k¼0.548). When comparing R2 and R0þR1 scores, reproducibility of readers' evaluation of bone margins increased ranging from substantial (k¼0.655) to perfect (k¼1.000). Inter-reader agreement ranged from fair (k¼0.308) to substantial (k¼0.633). Accuracy of the radiologist and orthopaedist ranged from 76% to 83% and from 68% to 72%, respectively. When comparing R2 and R0þR1 scores, the accuracy of both readers ranged from 83% to 100%. There was no association between local recurrence and margin scores of histology, MRI, and CT (p!0.058).
British Journal of Oral and Maxillofacial Surgery, 2017
The intraoperative cytological assessment of bony resection margins (ICAB) is a feasible diagnostic approach to support frozen section for assessment of invasion of margins of soft and hard tissue. However, complex resection margins could challenge both diagnostic approaches. Our objective here was to identify the limitations of intraoperative diagnostic methods for assessing margins. We present an advanced cytological approach to assess complex margins that may solve the problem. Data from 119 patients in whom frozen section was supported by ICAB, were reviewed and the reasons for false results analysed. In 35 patients with squamous cell carcinoma infiltrating bone, specimens (n=100) from the resection margin went through an intraoperative cell isolation process for the cytological assessment of bony margins (ICAB). The results were compared with the histological results of the corresponding margins of bone as a reference. Limitations to the assessment of operative bony margins intraoperatively included an infiltrative histological pattern of growth of the carcinoma, with carcinoma cells disseminated within the cancellous bone, complex and uneven resection margins with soft and bony tissue, inflammation, and signs of previous radiotherapy. Intraoperative cell isolation plus (ICICAB) allowed the microscopic assessment of up to 1 cm 3 of bony tissue to detect disseminated carcinoma cells within the cancellous bone with a sensitivity of 92.3% (95% CI 74.9% to 99.1%), and a specificity of 100% (95% CI 95.1% to 100%), and positive and negative predictive values of 100% (95% CI 85.8% to 100%) and 97.4% (95%CI 90.8% to 99.7%), respectively. Intraoperative cell isolation is a feasible new technique to support ICAB and frozen section in the assessment of bony and soft tissue margins.
Intraoperative Use of C-Arm Machine to Evaluate Bone Surgical Margin of Resected Mandible Specimen
Principle of every onco-surgery is to attain tumor free specimen margins. Development of high resolution imaging and navigational systems based on high-resolution computed tomography or magnetic resonance imaging with microscope-based navigation, allows excellent evaluation of surgical margins intra-operatively. However these systems are very expensive and not readily available. We report use of C-arm machine intra-operatively to screen and evaluate surgical margins of resected mandible specimen of ameloblastoma involving the body of left mandible.
Assessment of margins in resection specimens for head and neck malignancies
The study was carried out from January 2008 to December 2010 as a retrospective observational study. Tumour registers and computer data bases from the Department of Histopathology were analyzed for the cases of malignancies involving various head and neck sites (both extra oral and intra oral), that were sent for histopathological analysis after complete resection during the above mentioned 3 years.
Margin quality with Patient specific instruments (PSI) for bone tumor resection
2017
INTRODUCTION Bone tumour resection and subsequent reconstruction remains challenging for the surgeon. Obtaining adequate margins is mandatory to decrease the risk of local recurrence. Improving surgical margins quality without excessive resection, reducing surgical time and increasing the quality of the reconstruction are the main goals of today's research in bone tumour surgical management. With the outstanding improvements in imaging and computerised planning, it is now a standard. However, surgical accuracy is essential in orthopaedic oncologic surgery (Grimmer 2005). Patient specific instruments (PSI) may greatly improve the surgeon's ability to achieve the targeted resection. Thanks to its physical support, PSI can physically guide the blade yielding to a better control over the cutting process (Wong, 2014). Surgical time might significantly be reduced as well when compared to conventional method or navigated procedure. Finally, reconstruction may gain in rapidity and q...
Surgical Margins After Computer-Assisted Mandibular Reconstruction: A Retrospective Study
Frontiers in Oral Health, 2022
Purpose: The use of virtual surgical planning in head and neck surgery is growing strongly. In the literature, its validity, accuracy and clinical utility for mandibular reconstruction are widely documented. Virtual planning of surgical bone resection and reconstruction takes place several days before surgery and its very sensitive nature can negatively affect an intervention aimed at maximum precision in term of oncological safety.Methods: The study focuses on a retrospective evaluation of the surgical margins in 26 consecutive cases with oral cavity malignancy and who underwent computer-assisted mandibular resection/reconstruction guided by the different types of bone, periosteal and peri-mandibular tissue involvement. The goal was to analyze the strategic and technical aspects useful to minimize the risk of positive or close margins and to vary the reconstructive strategy in the case of intraoperative findings of a non-radical planned resection.Results: No intraoperative or perio...
Intraoperative radiological margin assessment in breast-conserving surgery
European Journal of Surgical Oncology (EJSO), 2014
A prospective study was lead in order to analyze the accuracy of an X-ray device settled in the operating room for margin assessment, when performing breast-conserving surgery. Patients and methods: One hundred and seventy patients were included. All lesions were visible on the preoperative mammograms. An intraoperative X-ray of the lumpectomy specimen was systematically performed for margins assessment. Final histological data were collected and the accuracy of intraoperative specimen radiography (IOSR) for margin assessment was analyzed. Results: IOSR allowed an evaluation of margins status in 155 cases (91.2%). After final histological examination, the positive margins rate would have been 6.5% if margin assessment had relied only on IOSR. Conclusion: Margin assessment with a two-dimensional X-ray device would have allowed the achievement of negative margins in 93.5% of the cases. Moreover, this procedure allows important time-saving and could have a substantial economical impact.