Frozen Section versus Gross Examination for Bone Marrow Margin Assessment During Sarcoma Resection

Anderson, Megan E.; Miller, Patricia E.; Nostrand, Kelsey Van; Vargas, Sara O.

doi:10.1007/s11999-013-3005-8

Cited by 11 publications

(8 citation statements)

References 7 publications

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“…Prior to the era of current advanced imaging modalities, intraoperative evaluation of the bone marrow by frozen section was the norm in surgical treatment of bone sarcomas [19]. This is time consuming, needs the availability of a dedicated pathologist for assessing the sample during surgery, and adds an additional financial cost to treatment [20]. Advances in imaging have improved our ability to accurately assess the extent of tumor on MRI.…”

Section: Discussionmentioning

confidence: 99%

“…Advances in imaging have improved our ability to accurately assess the extent of tumor on MRI. This can help reduce or obviate intraoperative frozen section sampling [20]. Anderson et al in a study of 142 patients concluded that frozen section can be omitted to determine the disease status at the osteotomy site [20] though they did suggest examination of the split gross specimen as an adjunct to clinical and radiological findings to ensure negative margins.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of MRI and Histopathology with regard to Intramedullary Extent of Disease in Bone Sarcomas

Gulia

Puri

Subi

et al. 2019

Sarcoma

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In today's era, limb salvage surgery is the procedure of choice and current standard of care in appropriately selected patients of bone sarcomas. For adequate oncologic clearance, preoperative evaluation of the extent of tumor is mandatory. The present study was done to compare measurements of bone sarcomas (osteosarcoma, Ewing's sarcoma, and chondrosarcoma) as determined by magnetic resonance imaging (MRI) with the histopathological extent seen on resected specimens. We prospectively evaluated 100 consecutive patients with a diagnosis of bone sarcoma who underwent limb salvage surgery between May 2014 and December 2014. The maximum longitudinal (cranio-caudal) dimension of tumor on the noncontrast T1-WI sequence of MRI (irrespective of whether it was pre/postchemotherapy) was compared with the gross dimensions of the tumor on histopathology. The arithmetic mean difference, Wilcoxon signed-rank test, and Spearman's correlation analysis were used to test the differences and correlation between groups. Mean tumor size on MRI based on the largest extent on MRI was 12.1 ± 4.85 cm (mean ± standard deviation), while it was 10.77 ± 4.6 cm (mean ± standard deviation) on histopathology. In 79 cases, MRI overestimated the extent of disease; the mean was 1.79 cm with a standard deviation of 1.56 cm. When the disease extent was underestimated on MRI (13 cases), the mean was 0.58 cm with a standard deviation of 0.43 cm. In 8 cases (osteosarcoma (7), Ewing's sarcoma (1)), MRI measurement was equal to histopathology. The Spearman correlation analysis showed a high correlation of tumor length on histopathology with the MRI for all patients (R = 0.948, P < 0.0001). We thus conclude that MRI is accurate in delineating the extent of bone sarcomas. A margin of 2 cm from the maximum tumor extent is adequate to ensure appropriate surgical resection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of MRI and Histopathology with regard to Intramedullary Extent of Disease in Bone Sarcomas

Gulia

Puri

Subi

et al. 2019

Sarcoma

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“…A 3–5 cm all around macroscopic margins were achieved. An intra-operative frozen section histological examination for microscopically clear margins was omitted to save operative and general anesthetic time [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant

et al. 2020

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Background Chest wall resection following wide local excision for bone tumor results in a large defect. Reconstructing this defect is complex and requires skeletal and soft tissue reconstruction. We describe the reconstruction of a large skeletal defect with a three-dimensional (3-D) printed custom-made, anatomically designed, titanium alloy ribs and hemi-sternum implant. Method To design the implant manual bone threshold segmentation was performed to create a 3-D virtual model of the patient’s chest and the tumor from sub-millimeter slice computed tomography (CT) scan data. We estimated the extent of resection needed to ensure tumor-free margins by growing the tumor by two cm all around.. We designed the implant using an anatomical image of the ribs and right hemi-sternum and then fabricated a 3D model of them in titanium metal using TiMG 1 powder bed fusion technology. At surgery the implant was slotted into the defect and sutured to the ribs laterally and hemi-sternum medially. Results Histology confirmed clear all around microscopic margins. Following surgery and at 18 month follow up the patient was asymptomatic with preserved quality of life and described no pain, localized tenderness or breathlessness. There was no displacement or paradoxical movement of the implant. Conclusion Our techniques of CT segmentation, editing, computer aided design of the implant and fabrication using laser printing of a custom-made anatomical titanium alloy chest wall ribs and hemi-sternum for reconstruction is feasible, safe and provides a satisfactory result. Hence, a patient specific 3-D printed titanium chest wall implant is another useful adjunct to the surgical approach for reconstructing large chest wall defects whilst preserving the anatomical shape, structure and function of the thorax.

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“…In addition, the bandsaw disrupts attached soft tissues, and there are limitations to the number of planes that can be sectioned. Even so, gross evaluation of the split bone sarcoma resection specimen performed during surgery can help to confirm a negative margin with enough confidence to obviate the need for frozen section, or it may trigger a surgeon's removal of additional tissue [1]. Occasionally, intraoperative gross assessment may help to target the best area to be sampled for frozen section with histologic evaluation.…”

Section: Sara O Vargas MD Staff Pathologist Boston Children's Hospitalmentioning

confidence: 99%

CORR® Tumor Board: Can Navigation Improve the Ability to Achieve Tumor-free Margins in Pelvic and Sacral Primary Bone Sarcoma Resections? A Historically Controlled Study

Anderson

Vargas

2019

Clin Orthop Relat Res

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Care for patients with bone sarcomas is inherently collaborative. Surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, physical therapists, social workers, basic scientists, biomedical engineers all bring their own expertise to the fold with the dual goals of beating the tumor and helping the patient to return to full function. There is no more perfect example of this than pelvic and sacral primary sarcomas. As noted by Bosma and colleagues [2], the most common sarcomas among adults in this location, chondrosarcoma and chordoma, do not respond well to systemic therapy [5]. Radiation generally has limited efficacy for bone sarcomas in all age groups, with the exception of Ewing sarcoma [4]. The bony pelvis and sacrum are such complex and important parts of the musculoskeletal system that reconstructive options require complicated biomedical engineering solutions. But these solutions have serious shortcomings, and so many patients will need extensive therapy, adaptive devices, and psychological support.Surgery remains the mainstay treatment for patients with pelvic and spinal sarcomas. In most patients with these diseases, other than those with Ewing sarcoma, if the tumor cannot be surgically removed in its entirety, the likelihood of a cure drops precipitously. Therefore, surgeons must collaborate with other specialists and incorporate technological advances with the goal of removing all of the tumor and preserving as much normal tissue as possible.Bosma and colleagues [2] investigate the application of computerassisted navigation to do just that. Their results demonstrate that resections performed with navigation were more likely to achieve adequate bone margins than those performed without navigation. The authors appropriately caution readers about the importance of being familiar and facile with the technology, and they correctly point out that the image-to-patient registration (which orients the computer to the local anatomy, making precision resections possible) is the most-important step in the procedure. I agree wholeheartedly with the authors on both of those points.We can also think about these complex resections and the other ways in which using advanced technology A note from the Editor-in-Chief: We are pleased to present the next installment of our CORR ® Tumor Board column, which provides multidisciplinary perspective on the themes raised in selected CORR ® tumor papers. In this column, we will discuss the implications of the highlighted article from the varied disciplines of the Tumor Board members: Orthopaedic surgery, pathology, and radiology. This month's column features the study "Can Navigation Improve the Ability to Achieve Tumor-free Margins in Pelvic and Sacral Primary Bone Sarcoma Resections? A Historically Controlled Study" by Bosma and colleagues

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Frozen Section versus Gross Examination for Bone Marrow Margin Assessment During Sarcoma Resection

Cited by 11 publications

References 7 publications

Comparison of MRI and Histopathology with regard to Intramedullary Extent of Disease in Bone Sarcomas

Comparison of MRI and Histopathology with regard to Intramedullary Extent of Disease in Bone Sarcomas

Chest wall reconstruction with an anatomically designed 3-D printed titanium ribs and hemi-sternum implant

CORR® Tumor Board: Can Navigation Improve the Ability to Achieve Tumor-free Margins in Pelvic and Sacral Primary Bone Sarcoma Resections? A Historically Controlled Study

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