Feasibility study of intraoperative cone‐beam CT navigation for benign bone tumour surgery

Steenbergen, Thomas R. F. van; Geest, I.C.M. van der; Janssen, Dennis; Rovers, Maroeska M.; Fütterer, Jurgen J.

doi:10.1002/rcs.1993

Cited by 9 publications

(5 citation statements)

References 20 publications

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“…However, in clinical practice, the position for PSI is more difficult than that in an experimental study because of the soft tissue surrounding the bone and the tumor. New imaging technologies such as O-arm CT [ 19 ] or cone-beam CT [ 20 , 21 ] have been used for navigation in recent years, and have also shown benefits for patients.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of bony resection under computer-assisted navigation for bone sarcomas around the knee

et al. 2023

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Background Computer-assisted navigation has made bone sarcoma resections more precise. However, further clinical studies involving accuracy analyses under navigation are still warranted. Methods A retrospective study for analysis of computer-assisted navigation accuracy was carried out. Between September 2008 and November 2017, 39 cases of bone sarcomas around the knee joint were resected under computer-assisted navigation. The control group comprised 117 cases of bone sarcomas around the knee treated by limb salvage surgery wherein bony cutting was achieved freehand. The length difference (LD) was defined as the specimen length minus the planned resection length. The LDs were detected in both groups and compared. The margin accuracy (MA) was defined as the achieved margin minus the desired margin at the bone cutting site and was detected in the navigation group. Results The LDs between the postoperative specimen length and the preoperative planned length were compared. In the navigation group, the LD was 0.5 ± 2.5 mm (range, − 5 to 5 mm), while in the freehand group, the LD was 3.4 ± 9.6 mm (range, − 20 to 29 mm), with a significant difference (P < 0.01). In the absolute value analysis, the LD absolute value was 2.0 ± 1.6 mm in the navigation group and 8.3 ± 6.0 mm in the freehand group, with a significant difference (P < 0.01). In the navigation group, the MA was 0.3 ± 1.5 mm (range, − 3 to 3 mm) and the MA absolute value was 1.1 ± 1.0 mm. Conclusions Better accuracy can be achieved when computer-assisted navigation is conducted for bone sarcoma resection around the knee. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Accuracy of bony resection under computer-assisted navigation for bone sarcomas around the knee

et al. 2023

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“…To lower the residual rate, navigated curettage or an intraoperative computed tomography might be used to verify complete tumor removal. 18 Clinical relevance could be questioned due to the benign nature of these residual tumors. 14 Five cases were diagnosed with chondrosarcoma grade 2 after curettage and cryosurgery.…”

Section: Discussionmentioning

confidence: 99%

Curettage and cryosurgery for enchondroma and atypical cartilaginous tumors of the long bones: Oncological results of a large series

Deckers

Leijer

Flucke

et al. 2021

Journal of Surgical Oncology

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Background and Objectives: Intralesional surgical treatment is the preferred therapy for atypical cartilaginous tumors (ACTs) of the long bones in many institutions. However, the literature is still controversial regarding intralesional treatment versus wide resection. Due to the relative rarity of these tumors, studies reporting on the results of intralesional treatment are often small sample studies. Methods: We retrospectively analyzed the oncological results of 55 enchondromas, 119 ACTs, and 5 chondrosarcomas grade 2 (CS2) treated with curettage and cryosurgery between the years 2004 and 2017 at our institution. The median follow-up period was 53 months (range, 24-169 months). Results: In total, seven cases (three ACT, four CS2) recurred. Residual tumor was detected in 20 cases. Three cases underwent secondary curettage and cryosurgery due to local recurrence. Four cases underwent wide resection and reconstruction due to local recurrence with aggressive imaging characteristics. In total, 20 postoperative complications were seen. Conclusion:Curettage and cryosurgery for enchondroma and ACT show very good oncological results with a low recurrence rate and acceptable complication rate.Curettage and cryosurgery is reliable as a surgical treatment for enchondroma and ACT. Further research should define the criteria for determining which specific cartilaginous tumors necessitate surgical treatment.

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“…These systems, and medical technology in general, should therefore only be used when there is an expected health benefit. Our previous study did report an added benefit of navigation to curettage in terms of more control in challenging locations (nearby vital structures) [ 5 ]. Cartiaux et al described such a location as having a narrow safety zone, i.e., little tolerance in relation to the surgical target, so accurate curettage is required [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical navigation has shown added benefit in bone sarcoma resections [ 2 ], with phantom and cadaver studies showing that the accuracy of navigated saw plane cuts was higher than freehand [ 3 , 4 ]. Substantially less studies were performed on navigated benign bone tumor curettage, with conflicting results on its added benefit and difficult to compare studies as operating techniques and choice of adjuvants differed [ 5 – 7 ]. Furthermore, the question remains what the effect of navigation is on the accuracy of curettage, regardless of adjuvant therapy.…”

Section: Introductionmentioning

confidence: 99%

The accuracy of navigated versus freehand curettage in bone tumors: a cadaveric model study

et al. 2022

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Purpose Navigation has been suggested to guide complex benign bone tumor curettage procedures, but the contribution of navigation to the accuracy of curettage has never been quantified. We explored the accuracy of navigated curettage in a cadaveric observational pilot study, comparing navigated to freehand curettage, performed independently by an expert and a novice user. Methods The expert performed curettage on 20 cadaveric bones prepared with a paraffin wax mixture tumor, 10 freehand and 10 navigated. We re-used 12 bones for the novice experiments, 6 freehand and 6 navigated. Tumor and curettage cavity volumes were segmented on pre- and post-cone-beam CT scans. Accuracy was quantified using the Dice Similarity Coefficient (DSC), and with remaining tumor volume, bone curettage volume, maximal remaining width and procedure times compared between navigation and freehand groups for both users. Results There were little differences in curettage accuracy between a navigated (DSC 0.59[0.17]) and freehand (DSC 0.64[0.10]) approach for an expert user, but there were for a novice user with DSC 0.67(0.14) and 0.83(0.06), respectively. All navigated and freehand procedures had some amount of remaining tumor, generally located in a few isolated spots with means of 2.2(2.6) cm3 (mean 20% of the tumor volume) and 1.5(1.4) cm3 (18%), respectively, for the expert and more diffusely spaced with means of 5.1(2.8) cm3 (33%) and 3.0(2.2) cm3 (17%), respectively, for the novice. Conclusions In an explorative study on 20 cadaveric bone tumor models, navigated curettage in its current setup was not more accurate than freehand curettage. The amount of remaining tumor, however, confirms that curettage could be further improved. The novice user was less accurate using navigation than freehand, which could be explained by the learning curve. Furthermore, the expert used a different surgical approach than the novice, focusing more on removing the entire tumor than sparing surrounding bone.

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Feasibility study of intraoperative cone‐beam CT navigation for benign bone tumour surgery

Cited by 9 publications

References 20 publications

Accuracy of bony resection under computer-assisted navigation for bone sarcomas around the knee

Accuracy of bony resection under computer-assisted navigation for bone sarcomas around the knee

Curettage and cryosurgery for enchondroma and atypical cartilaginous tumors of the long bones: Oncological results of a large series

The accuracy of navigated versus freehand curettage in bone tumors: a cadaveric model study

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