MRI Evaluation of Resection Margins in Bone Tumour Surgery

Vandergugten, Simon; Traore, Sidi Yaya; Cartiaux, Olivier; Lecouvet, Frédéric; Galant, Christine; Docquier, Pierre-Louis

doi:10.1155/2014/967848

Cited by 8 publications

(2 citation statements)

References 8 publications

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“…Several authors have pursued similar methods in an effort to provide surgeons with accurate perioperative information on the margin status in tumors other than VSCC. Previously, breast, bone, gastric, esophageal, tongue and prostate specimens have been examined by ex vivo MRI. As far as we are aware, employing ex vivo MRI in RLE specimens is new, but other (imaging) techniques such as FSA and optical coherence tomography (OCT) have been investigated as a means to assess the surgical tumor‐free margins.…”

Section: Discussionmentioning

confidence: 99%

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

et al. 2018

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In the surgical treatment of vulvar squamous‐cell carcinoma (VSCC), tumor‐free margins of 8 mm or more are considered adequate. However, limited perioperative information on the tumor‐free margins other than the surgeon's own estimation is available. The purpose of this study was therefore to investigate the feasibility of ex vivo MRI in localizing VSCC and to assess the surgical tumor‐free margins in fresh radical local excision (RLE) specimens to guide the surgeon during resections. Nine patients with biopsy‐proven VSCC scheduled for RLE were prospectively included. Intact fresh specimens were scanned using a 7 T preclinical MR‐scanner. Whole mount H&E‐stained slides were obtained every 3 mm and correlated with ex vivo MRI. A pathologist annotated VSCC and minimal tumor‐free margins (3 o'clock, 9 o'clock, basal) on the digitalized histological slides. An observer with knowledge of histology (the non‐blinded annotation) and a radiologist blinded to histology (the blinded annotation) separately performed annotation of the same features on ex vivo MRI. Linear correlation and agreement of the ex vivo MRI measurements with histology were assessed. Diagnostic performance for VSCC localization and identification of margins less than 8 mm was expressed as positive and negative predictive values (PPV, NPV). In 153 matched ex vivo MRI slices, the observer correctly identified 79/91 margins as less than 8 mm (PPV 87%) and 110/124 margins as 8 mm or greater (NPV 89%). The radiologist correctly annotated absence of VSCC in 73/81 (NPV 90%) and presence in 65/72 (PPV 90%) slices. Sixty‐four of 90 margins were correctly identified as less than 8 mm (PPV 71%) and 83/102 margins as 8 mm or greater (NPV 81%). Both non‐blinded and blinded annotations were linearly correlated and demonstrated good agreement with histology. Accurate localization of VSCC and measurements of the surgical tumor‐free margins in fresh RLE specimens using ex vivo MRI seems feasible. High diagnostic performance in VSCC localization and identification of margins less than 8 mm suggest ex vivo MRI to be clinically applicable.

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Section: Discussionmentioning

confidence: 99%

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

et al. 2018

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“…Furthermore, obtaining an accurate analysis of the whole specimen is often difficult. The postoperative evaluation of resection margins by MRI [ 11 – 13 ] has been proposed in the published literature. MRI evaluation is more rapid and can be used to assess the whole specimen easily, including those with voluminous tumors.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Resection Margins in Bone Tumor Surgery

Malherbe

Crutzen

Schrooyen

et al. 2020

Sarcoma

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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 similar results for both the qualitative (all resections were R0) and quantitative assessments. The median error in safe margins was 2 mm with a surgical guide (PSI) and 5 mm without a surgical guide. Local recurrences were not detected after a mean follow-up period of 3.7 years (range, 2.1–5 years); however, four patients died during the study. In conclusion, MRI is a valuable tool for assessing safe margins. When specimens are not available for pathological assessment (e.g., extracorporeally irradiated autograft or autoclaved autograft), MRI could be used to evaluate margins. In particular, when tumor volume is high, MRI could also help to focus the pathological examination on areas of concern.

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Evaluation of tongue squamous cell carcinoma resection margins using ex-vivo MR

et al. 2017

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PurposePurpose of this feasibility study was (1) to evaluate whether application of ex-vivo 7T MR of the resected tongue specimen containing squamous cell carcinoma may provide information on the resection margin status and (2) to evaluate the research and developmental issues that have to be solved for this technique to have the beneficial impact on clinical outcome that we expect: better oncologic and functional outcomes, better quality of life, and lower costs.MethodsWe performed a non-blinded validation of ex-vivo 7T MR to detect the tongue squamous cell carcinoma and resection margin in 10 fresh tongue specimens using histopathology as gold standard.ResultsIn six of seven specimens with a histopathologically determined invasion depth of the tumor of mm, the tumor could be recognized on MR, with a resection margin within a 2 mm range as compared to histopathology. In three specimens with an invasion depth of mm, the tumor was not visible on MR. Technical limitations mainly included scan time, image resolution, and the fact that we used a less available small-bore 7T MR machine.ConclusionEx-vivo 7T probably will have a low negative predictive value but a high positive predictive value, meaning that in tumors thicker than a few millimeters we expect to be able to predict whether the resection margin is too small. A randomized controlled trial needs to be performed to show our hypothesis: better oncologic and functional outcomes, better quality of life, and lower costs.

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MRI Evaluation of Resection Margins in Bone Tumour Surgery

Cited by 8 publications

References 8 publications

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

Assessment of Resection Margins in Bone Tumor Surgery

Evaluation of tongue squamous cell carcinoma resection margins using ex-vivo MR

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