scholarly journals Performance of Intraoperative Assessment of Resection Margins in Oral Cancer Surgery: A Review of Literature

2021 ◽  
Vol 11 ◽  
Author(s):  
Elisa M. Barroso ◽  
Yassine Aaboubout ◽  
Lisette C. van der Sar ◽  
Hetty Mast ◽  
Aniel Sewnaik ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Oral Cancer ◽  
Local Recurrence ◽  
Sensitivity And Specificity ◽  
Clinical Relevance ◽  
Cancer Surgery ◽  
Margin Status ◽  
Resection Margins ◽  
Intraoperative Assessment ◽  
Average Accuracy

IntroductionAchieving adequate resection margins during oral cancer surgery is important to improve patient prognosis. Surgeons have the delicate task of achieving an adequate resection and safeguarding satisfactory remaining function and acceptable physical appearance, while relying on visual inspection, palpation, and preoperative imaging. Intraoperative assessment of resection margins (IOARM) is a multidisciplinary effort, which can guide towards adequate resections. Different forms of IOARM are currently used, but it is unknown how accurate these methods are in predicting margin status. Therefore, this review aims to investigate: 1) the IOARM methods currently used during oral cancer surgery, 2) their performance, and 3) their clinical relevance.MethodsA literature search was performed in the following databases: Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar (from inception to January 23, 2020). IOARM performance was assessed in terms of accuracy, sensitivity, and specificity in predicting margin status, and the reduction of inadequate margins. Clinical relevance (i.e., overall survival, local recurrence, regional recurrence, local recurrence-free survival, disease-specific survival, adjuvant therapy) was recorded if available.ResultsEighteen studies were included in the review, of which 10 for soft tissue and 8 for bone. For soft tissue, defect-driven IOARM-studies showed the average accuracy, sensitivity, and specificity of 90.9%, 47.6%, and 84.4%, and specimen-driven IOARM-studies showed, 91.5%, 68.4%, and 96.7%, respectively. For bone, specimen-driven IOARM-studies performed better than defect-driven, with an average accuracy, sensitivity, and specificity of 96.6%, 81.8%, and 98%, respectively. For both, soft tissue and bone, IOARM positively impacts patient outcome.ConclusionIOARM improves margin-status, especially the specimen-driven IOARM has higher performance compared to defect-driven IOARM. However, this conclusion is limited by the low number of studies reporting performance results for defect-driven IOARM. The current methods suffer from inherent disadvantages, namely their subjective character and the fact that only a small part of the resection surface can be assessed in a short time span, causing sampling errors. Therefore, a solution should be sought in the field of objective techniques that can rapidly assess the whole resection surface.

scholarly journals Association of Main Specimen and Tumor Bed Margin Status With Local Recurrence and Survival in Oral Cancer Surgery

2016 ◽  
Vol 142 (12) ◽  
pp. 1191 ◽  
Author(s):  
Marisa R. Buchakjian ◽  
Kendall K. Tasche ◽  
Robert A. Robinson ◽  
Nitin A. Pagedar ◽  
Steven M. Sperry
Keyword(s):  
Oral Cancer ◽  
Local Recurrence ◽  
Cancer Surgery ◽  
Margin Status ◽  
Tumor Bed

scholarly journals Specimen‐driven intraoperative assessment of resection margins should be standard of care for oral cancer patients

Oral Diseases ◽  
2020 ◽  
Vol 27 (1) ◽  
pp. 111-116 ◽  
Author(s):  
Yassine Aaboubout ◽  
Ivo ten Hove ◽  
Roeland W. H. Smits ◽  
Jose A. Hardillo ◽  
Gerwin J. Puppels ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Cancer Patients ◽  
Standard Of Care ◽  
Resection Margins ◽  
Intraoperative Assessment ◽  
Oral Cancer Patients

scholarly journals Intraoperative Evaluation of Resection Margins in Breast-Conserving Surgery for In Situ and Invasive Breast Carcinoma

2021 ◽  
Vol 15 ◽  
pp. 117822342199345
Author(s):  
Caroline Koopmansch ◽  
Jean-Christophe Noël ◽  
Calliope Maris ◽  
Philippe Simon ◽  
Marième Sy ◽  
...  
Keyword(s):  
Invasive Carcinoma ◽  
Tumour Size ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Resection Margins ◽  
Margin Assessment ◽  
Positive Margins ◽  
Intraoperative Assessment ◽  
Intraoperative Margin Assessment

Background: The challenge of breast-conserving surgery (BCS) is to remove the entire tumour with free margins and avoid secondary excision that may adversely affect the cosmetic outcome. Consequently, intraoperative evaluation of surgical margins is critical. The aims of this study were multiple. First, to analyse our methodology of intraoperative examination of the resection margins and to evaluate radiological and pathological methods in the assessment of the surgical margins. Second, to evaluate the factors associated with positive margins in our patient population. M&m: The data on the resection margin status of 290 patients who underwent BCS for invasive carcinoma or ductal carcinoma in situ (DCIS) between 2009 and 2016 were reviewed. Results: In the cohort of BCS with invasive carcinoma, the negative predictive value was 97.4% for intraoperative assessment by radiography and 81.8% for intraoperative assessment by pathology. The re-operation rate among cases without intraoperative assessment was 23.6% compared to 7.3% among cases with intraoperative assessment ( P = .003). Margin status was significantly associated with tumour size, histological subtype (invasive lobular carcinoma), and multifocality. In the population of BCS with DCIS, margin status was significantly associated with preoperative localisation and intraoperative margin assessment ( P = .03). Conclusion: There is no statistical difference between pathological and radiological intraoperative assessment. Tumour size, lobular subtype, and multifocality were found to be significantly associated with positive margins in cases with invasive carcinoma, whereas absence of intraoperative margin assessment was significantly associated with positive margins in cases with DCIS. Therefore, intraoperative margin assessment improves the likelihood of complete excision of the lesion.

scholarly journals Detecting tumour-positive resection margins after oral cancer surgery by spraying a fluorescent tracer activated by gamma-glutamyltranspeptidase

Oral Oncology ◽  
2018 ◽  
Vol 78 ◽  
pp. 1-7 ◽  
Author(s):  
Maxime D. Slooter ◽  
Henricus J.M. Handgraaf ◽  
Martin C. Boonstra ◽  
Lily-Ann van der Velden ◽  
Shadhvi S. Bhairosingh ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Cancer Surgery ◽  
Resection Margins ◽  
Fluorescent Tracer ◽  
Positive Resection Margins

Touch prep (TP) cytology as a tool for determining pulmonary parenchymal resection margin status

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18095-18095
Author(s):  
K. M. Brown ◽  
J. Flaherty ◽  
V. Ciocca ◽  
H. Ehya ◽  
W. Scott ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Wedge Resection ◽  
Accurate Determination ◽  
Lung Lesion ◽  
Margin Status ◽  
Resection Margins ◽  
Logrank Test ◽  
Lung Cancers ◽  
Promising Tool ◽  
Metastatic Lung

18095 Background: Accurate determination of parenchymal resection margins is critical in excision of primary and metastatic lung cancers. Complete microscopic examination of the entire margin is difficult and may not give timely results. Staple-line excision may compromise the accuracy of histologic margin exam (HME). TP offers a novel method to obtain pulmonary parenchymal margin status intraoperatively. Methods: Patients undergoing wedge resection for a known malignant lung lesion were studied prospectively. At the time of resection, the specimen stapled margin underwent TP on 3 glass slides for cytological analysis. The presence or absence of malignant cells on TP was correlated to final HME. Local recurrence and overall survival by TP and HME status were compared using logrank test. Results: Thirty specimens from 29 patients were studied between December 2002 and April 2006. Fifteen specimens (50%) were right- sided; 9/29 patients (31%) were male. Median age was 66 years (range 28 - 81). Histologies included non-small cell lung cancer (NSCLC) in 22 (73%), and metastases from colorectal cancer (4/30, 13%), sarcoma (2/20, 7%), and breast (1/30, 3%). All TP negative specimens had negative HME. TP was positive in 10 of 30 (33%) specimens, 6 of which had negative HME. These included 4 NSCLC and metastases from sarcoma (1) and colon (1). Mean margin distance was 4 ± 1.7 mm for TP/HME negative specimens, 0.5 ± 0 mm for TP/HME positive specimens, and 5 ± 1.7 mm for TP positive/HME negative patients. There was no difference in time to local recurrence between patients with positive margins by TP vs HME (18.6 and 18.63 months), or in TP and HME negative patients (30.1 and 30.6 months). Conclusion: TP analysis of lung parenchymal margins is safe and feasible. A negative TP is highly predictive of negative HME. Factors contributing to false-positive TP remain unresolved. Multi-institutional prospective studies are indicated for further characterization of this promising tool. No significant financial relationships to disclose.

Limb preserving surgery for soft-tissue sarcoma in the hand: a retrospective study of 51 cases

2020 ◽  
Vol 45 (6) ◽  
pp. 629-635 ◽  
Author(s):  
Mehran Dadras ◽  
Hans-Ulrich Steinau ◽  
Ole Goertz ◽  
Marcus Lehnhardt ◽  
Björn Behr ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Tumour Size ◽  
Long Term Results ◽  
Resection Margins ◽  
Incomplete Resection ◽  
Free Survival

Our retrospective study analysed the long-term results of a conservative limb-preserving surgical strategy in 51 patients with soft-tissue sarcoma of the hand from a single institution. We assessed survival and prognostic factors, including the surgical margins. No transradial amputations were performed. Microscopically free resection margins were obtained in 45 of the patients. The remaining six patients had microscopically incomplete resection. Forty-four surviving patients had a median follow-up of 6.5 years (range 12–307), and one patient had no follow-up beyond 3 months following surgery. Among those patients, 29 had more than 5 years of follow-up. Five-year local-recurrence-free survival was 65%, metastasis-free survival was 84%, and disease-specific survival was 91%. Tumour size was predictive of all outcome parameters, but positive resection margins adversely affected local recurrence only. Survival was similar to the survival after a more radical surgical approach reported in the literature. Level of evidence: IV

scholarly journals Margin Assessment in Soft Tissue Sarcomas: Review of the Literature

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1687
Author(s):  
Andrea Sambri ◽  
Emilia Caldari ◽  
Michele Fiore ◽  
Riccardo Zucchini ◽  
Claudio Giannini ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Resection Margin ◽  
Soft Tissue Sarcomas ◽  
Margin Status ◽  
Treatment Modalities ◽  
Resection Margins ◽  
Margin Width ◽  
Tumor Boards ◽  
Resection Margin Status ◽  
Surgical Resection Margin

Adequacy of margins must take into consideration both the resection margin width (quantity) and anatomic barrier (quality). There are several classification schemes for reporting surgical resection margin status for soft tissue sarcomas (STS). Most of the studies regarding treatment outcomes in STS included all histologic grades and histological subtypes, which include infiltrative and non-infiltrative subtypes and are very heterogeneous in terms of both histologic characteristics and treatment modalities (adjuvant treatments or not). This lack of consistency makes it difficult to compare results from study to study. Therefore, there is a great need for evidence-based standardization concerning the width of resection margins. The aim of this narrative review is to provide a comprehensive assessment of the literature on margins, and to highlight the need for a uniform description of the margin status for patients with STS. Patient cases should be discussed at multidisciplinary tumor boards and treatments should be individualized to clinical and demographic characteristics, which must include also a deep knowledge of specific histotypes behaviors, particularly infiltrative ones.

scholarly journals Classification of Soft Tissue Sarcoma Specimens with Raman Spectroscopy as Smart Sensing Technology

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Liming Li ◽  
Vamiq M. Mustahsan ◽  
Guangyu He ◽  
Felix B. Tavernier ◽  
Gurtej Singh ◽  
...  
Keyword(s):  
Raman Spectroscopy ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Real Time ◽  
Frozen Section ◽  
Margin Status ◽  
Resection Margins ◽  
Analytical Methodology ◽  
Sensing Technology

Intraoperative confirmation of negative resection margins is an essential component of soft tissue sarcoma surgery. Frozen section examination of samples from the resection bed after excision of sarcomas is the gold standard for intraoperative assessment of margin status. However, it takes time to complete histologic examination of these samples, and the technique does not provide real-time diagnosis in the operating room (OR), which delays completion of the operation. This paper presents a study and development of sensing technology using Raman spectroscopy that could be used for detection and classification of the tumor after resection with negative sarcoma margins in real time. We acquired Raman spectra from samples of sarcoma and surrounding benign muscle, fat, and dermis during surgery and developed (i) a quantitative method (QM) and (ii) a machine learning method (MLM) to assess the spectral patterns and determine if they could accurately identify these tissue types when compared to findings in adjacent H&E-stained frozen sections. High classification accuracy (>85%) was achieved with both methods, indicating that these four types of tissue can be identified using the analytical methodology. A hand-held Raman probe could be employed to further develop the methodology to obtain spectra in the OR to provide real-time in vivo capability for the assessment of sarcoma resection margin status.

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