Assessment of the deep resection margin during oral cancer surgery: A systematic review

Koning, Susan G. Brouwer de; Schaeffers, Anouk W M A; Schats, Winnie; Brekel, M.W.M. van den; Ruers, T.J.M.; Karakullukçu, Barış

doi:10.1016/j.ejso.2021.04.016

Cited by 26 publications

(22 citation statements)

References 93 publications

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“…Other techniques are Raman spectroscopy, diffuse reflectance spectroscopy, hyperspectral imaging, and optical coherence tomography. All these techniques struggle with superficial sampling depth, which is insufficient to rule out close tumor‐free margins 34 . Frozen section analysis is a routinely used technique in daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound‐guided resection for squamous cell carcinoma of the buccal mucosa: A feasibility study

et al. 2022

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Background Image‐guided surgery could help obtain clear (≥5.0 mm) resection margins. This feasibility study investigated ultrasound‐guided resection accuracy of buccal mucosa squamous cell carcinoma (BMSCC). Methods MRI and ultrasound measurements of tumor thickness were compared to histology in 13 BMSCC‐patients. Ultrasound measured margins (at five locations) on the specimen were compared to the corresponding histological margins. Results Accuracy of in‐ and ex‐vivo ultrasound (mean deviation from histology: 1.6 mm) for measuring tumor thickness was comparable to MRI (mean deviation from histology: 2.6 mm). The sensitivity to detect clear margins using ex‐vivo ultrasound was low (48%). If an ex‐vivo ultrasound cutoff of ≥7.5 mm would be used, the sensitivity would increase to 86%. Conclusions Ultrasound‐guided resection of BMSCC's is feasible. In‐ and ex‐vivo ultrasound measure tumor thickness in BMSCC accurately. We recommend ≥7.5 mm resection margins on ex‐vivo ultrasound to obtain histological clear margins. Additional research is required to establish the effect of 7.5 mm ultrasound cutoff.

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Section: Discussionmentioning

confidence: 99%

“…However, it is invasive because of intravenous injection of conjugated antibodies. Moreover, the sampling depth is less than 5.0 mm 34 . Other techniques are Raman spectroscopy, diffuse reflectance spectroscopy, hyperspectral imaging, and optical coherence tomography.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided resection for squamous cell carcinoma of the buccal mucosa: A feasibility study

et al. 2022

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“…The proposed technique to assess tumoral margins is one of many novel techniques that have been proposed to increase the intraoperative identification of malignant tumor [29]. However, these techniques are characterized by inherent limitations, of which one recurring limitation is the limited penetration depth resulting in a limited assessment of the deep resection margins [8]. This lack of three-dimensional insight results in a difficult identification of the malignant tumor with sufficient accuracy and certainty.…”

Section: Discussionmentioning

confidence: 99%

“…While recent advances have been proposed to increase the accuracy of margin assessment in a multitude of tumor types, assessing the deep margins with sufficient accuracy remains an important limitation in most proposed techniques [8]. Over the last decade, several techniques that could potentially enable intraoperative margin assessment, such as fluorescence, hyperspectral imaging, spectroscopy and radioguided surgery, have been and still are being evaluated, with varying success [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

High-Resolution 18F-FDG PET/CT for Assessing Three-Dimensional Intraoperative Margins Status in Malignancies of the Head and Neck, a Proof-of-Concept

Debacker,

Schelfhout,

Brochez

et al. 2021

JCM

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The surgical treatment of head and neck malignancies relies on the complete removal of tumoral tissue, while inadequate margins necessitate the use of adjuvant therapy. However, most positive margins are identified postoperatively as deep margins, and intraoperative identification of the deep positive margins could help achieve adequate surgical margins and decrease adjuvant therapies. To improve deep-margin identification, we investigated whether the use of high-resolution preclinical PET and CT could increase certainty about the surgical margins in three dimensions. Patients with a malignancy of the head and neck planned for surgical resection were administered a clinical activity of 4MBq/kg 18F-FDG approximately one hour prior to surgical initiation. Subsequently, the resected specimen was scanned with a micro-PET-CT imaging device, followed by histopathological assessment. Eight patients were included in the study and intraoperative PET/CT-imaging of 11 tumoral specimens and lymph nodes of three patients was performed. As a result of the increased resolution, differentiation between inflamed and dysplastic tissue versus malignant tissue was complicated in malignancies with increased peritumoral inflammation. The current technique allowed the three-dimensional delineation of 18F-FDG using submillimetric PET/CT imaging. While further optimization and patient stratification is required, clinical implementation could enable deep margin assessment in head and neck resection specimens.

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“…Over the past two decades, important advances have been made to improve assessment of surgical margins by the introduction of intraoperative imaging techniques. Besides frozen section analysis, several optical methods have been studied to perform intraoperative margin assessment in surgical oncology, including optical coherence tomography (OCT) [36], photoacoustic tomography, terahertz imaging, second harmonic generation, confocal microscopy, fluorescence (lifetime) imaging, autofluorescence imaging (AFI), narrow-band imaging, hyper-spectral imaging, diffuse reflectance spectroscopy, Fourier transform infrared spectroscopy, and Raman spectroscopy (RS) [37][38][39][40][41][42]. Among them, intraoperative fluorescence imaging (FLI) using exogenous tumour-specific fluorescent agents has shown to be particularly beneficial for surgical margin assessment in clinical trials [43][44][45][46][47][48][49][50][51][52][53][54], and it has been shown that RS can objectively discriminate between normal and malignant tissue [55][56][57][58][59].…”

Section: Introductionmentioning

confidence: 99%

The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles

Lauwerends

Abbasi

Schut

et al. 2022

Eur J Nucl Med Mol Imaging

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A clear margin is an important prognostic factor for most solid tumours treated by surgery. Intraoperative fluorescence imaging using exogenous tumour-specific fluorescent agents has shown particular benefit in improving complete resection of tumour tissue. However, signal processing for fluorescence imaging is complex, and fluorescence signal intensity does not always perfectly correlate with tumour location. Raman spectroscopy has the capacity to accurately differentiate between malignant and healthy tissue based on their molecular composition. In Raman spectroscopy, specificity is uniquely high, but signal intensity is weak and Raman measurements are mainly performed in a point-wise manner on microscopic tissue volumes, making whole-field assessment temporally unfeasible. In this review, we describe the state-of-the-art of both optical techniques, paying special attention to the combined intraoperative application of fluorescence imaging and Raman spectroscopy in current clinical research. We demonstrate how these techniques are complementary and address the technical challenges that have traditionally led them to be considered mutually exclusive for clinical implementation. Finally, we present a novel strategy that exploits the optimal characteristics of both modalities to facilitate resection with clear surgical margins.

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Assessment of the deep resection margin during oral cancer surgery: A systematic review

Cited by 26 publications

References 93 publications

Ultrasound‐guided resection for squamous cell carcinoma of the buccal mucosa: A feasibility study

Ultrasound‐guided resection for squamous cell carcinoma of the buccal mucosa: A feasibility study

High-Resolution 18F-FDG PET/CT for Assessing Three-Dimensional Intraoperative Margins Status in Malignancies of the Head and Neck, a Proof-of-Concept

The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles

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