The computer‐aided design margin: Ex vivo 3D specimen mapping to improve communication between surgeons and pathologists

Abstract

Background Numerous challenges exist in determining surgical margin status. Communication between surgeons and pathologists is crucial for specimen orientation and accurate margin assessment. Methods A prospective study to determine feasibility of incorporating three‐dimensional (3D) scanning into surgical pathology workflow was performed. A structured‐light 3D scanner captured the photorealistic surface topography of fresh surgical specimens. Computer‐aided design (CAD) software was used to document sites of margin sampling and sectioning. Surveys were distributed among faculty and staff stakeholders to assess feasibility. Results A series of 40 cases were 3D‐scanned. Median image acquisition time was 8 min. The majority of respondents agreed that the experimental 3D system helped achieve clearer communication. 3D specimen maps assisted in the communication of a focally positive or close margin in 4 of 17 cases. Conclusions Routine 3D scanning and specimen mapping is feasible and represents an innovative approach to intraoperative and final pathology documentation, margin analysis, and surgeon–pathologist communication.

The art of specimen orientation: Two‐dimensional maps for oropharynx squamous cell carcinoma

“…New studies explore the use of intraoperative scanning of specimens to build a 3D computer-generated map for specimen orientation. [9][10][11] Unlike these methods, however, which require an intraoperative 3D scanner and designated personnel, our 2D maps are standardized and easily adapted to the surgeon and pathologist workup with minimally added time and tools.…”

“…However, there are limitations to representation of 3D specimens in a 2D map which may alter the true anatomic position of the tumor or margin in the context of surrounding anatomy. New studies explore the use of intraoperative scanning of specimens to build a 3D computer‐generated map for specimen orientation 9–11 . Unlike these methods, however, which require an intraoperative 3D scanner and designated personnel, our 2D maps are standardized and easily adapted to the surgeon and pathologist workup with minimally added time and tools.…”

Virtual Resection Specimen Interaction Using Augmented Reality Holograms to Guide Margin Communication and Flap Sizing

“…$3500, with other models currently on the market being more affordable). Current limitations include the accuracy of the scan, which could be addressed by using a commercial desktop 3D scanner that has been validated for specimens in head‐neck surgery 8 . Additionally, the accuracy and stability of the 3D specimen hologram warrant further investigation when translating this technique into the OR.…”

Surgical Margins in Musculoskeletal Sarcoma

“…Recently, Sharif et al published a feasibility study using 3D scanning of resected head and neck tumors to aid pathologists and surgeons with margin assessment. After scanning, computer-aided design software is used to document sites of margin sampling and sectioning, enabling clear communication of focally positive or close margins and the total surface area involved by the positive margin 98 . Further research into 3D analysis of margins in musculoskeletal sarcoma surgery should be considered given the wide variation of tumor shapes and anatomic locations encountered.…”