Lador Ran, Gasbarrini Alessandro, Gambarotti Marco, Bandiera Stefano, Ghermandi Riccardo, Boriani Stefano
Unit of Spine Surgery, Tel-Aviv Medical Center, 6 Weizman St., Tel-Aviv, 64239, Israel.
Unit of Oncologic Spine Surgery, Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy.
Eur Spine J. 2018 Apr;27(4):868-873. doi: 10.1007/s00586-017-4967-0. Epub 2017 Feb 6.
En bloc resections aim at surgically removing a tumor in a single, intact piece, fully encased by a continuous shell of healthy tissue-the "margin". Intraoperative continuous assessment of the plane of resection regarding the tumor's margins is paramount. The goal of this study was to evaluate the accuracy of experienced spinal tumor surgeons' perception of these margins.
A retrospective analysis of a prospectively collected data of 1681 patients affected by spine tumors of whom 217 en bloc resections was performed. Surgeons' intraoperative assessment was compared to the histopathological assessment.
Most were primary-163 (42 benign and 121 malignant), metastases occurred in 54 cases. 'Wide' margins were obtained in 126 cases; 'marginal' in 60 cases, and 'intralesional' in 31 cases. Surgeons assessed clear margins in 109 cases and contaminated in 108 cases. When considering marginal margins as a contaminated resection, the surgeon's assessment of clear resection had a sensitivity of 76.89%, specificity of 86.81%, PPV and NPV (positive and negative predictive values) were 88.99 and 73.15%, respectively. Inter-observer agreement was 0.62. When considering marginal margins as a clear resection, the surgeon's assessment of clear resection had a sensitivity of 64.5%, specificity of 100%, PPV and NPV were 100 and 0%, respectively. Inter-observer agreement was 0.29.
Surgeons are fairly accurate in their intraoperative assessment of clear margins achieved; however, this accuracy is not perfect and exploring ways to improve this intraoperative assessment is of major importance possibly impacting the outcome of the treatment.
整块切除术旨在通过手术完整切除肿瘤，肿瘤被连续的健康组织“边缘”完全包裹。术中持续评估肿瘤边缘的切除平面至关重要。本研究的目的是评估经验丰富的脊柱肿瘤外科医生对这些边缘的判断准确性。
对前瞻性收集的1681例脊柱肿瘤患者的数据进行回顾性分析，其中217例进行了整块切除术。将外科医生的术中评估与组织病理学评估进行比较。
大多数为原发性肿瘤——163例（42例良性和121例恶性），54例发生转移。126例获得“广泛”边缘；60例为“边缘性”，31例为“瘤内”。外科医生评估109例边缘清晰，108例有污染。将边缘性边缘视为污染性切除时，外科医生对清晰切除的评估敏感性为76.89%，特异性为86.81%，阳性预测值和阴性预测值分别为88.99%和73.15%。观察者间一致性为0.62。将边缘性边缘视为清晰切除时，外科医生对清晰切除的评估敏感性为64.5%，特异性为100%，阳性预测值和阴性预测值分别为100%和0%。观察者间一致性为0.29。
外科医生在术中对获得的清晰边缘的评估相当准确；然而，这种准确性并不完美，探索改善这种术中评估的方法非常重要，这可能会影响治疗结果。
