Pennington Zach, Ahmed A Karim, Cottrill Ethan, Westbroek Erick M, Goodwin Matthew L, Sciubba Daniel M
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Transl Med. 2019 May;7(10):225. doi: 10.21037/atm.2019.01.59.
Primary sarcomas of the vertebral column affect roughly 5 in every million persons annually, of which half to one-third are malignant. Treatment of these lesions requires multimodal management, often employing attempts at resection of the lesion with negative margins. This may be facilitated using magnetic resonance imaging for preoperative margin planning, but current literature is lacking regarding the use of such imaging to accurately predict planned surgical margins. Here we review prior studies describing the use of magnetic resonance imaging for resection of sarcomas of the extremities to identify learning points for application to the treatment of spinal neoplasms. We conducted a systematic review of the PubMed and EMBASE literature. Included studies described the accuracy of MRI for preoperative evaluation of tumor margins, intraoperative guidance for resection, or post-operative evaluation of residual or recurrent disease. All included studies described patients treated for osseous or soft tissue sarcoma of the limbs. We found 1,705 unique references of which 27 met criteria for inclusion. Seven studies reported MR had an overall diagnostic accuracy of 93.6-96% for preoperative margin evaluation with non-contrast T1 most accurately reflecting true margins. In the nine articles reporting results of MR-guided resection, negative margins were achieved in 88.8-100% of cases with a closest margin of 2-4 mm. Eleven articles combined reported the accuracy of MR for residual disease or local recurrence, with a mean sensitivity and specificity of 71.7% and 79.3%, respectively for residual disease and 87.9% and 85.9%, respectively for local recurrence. The current literature for appendicular musculoskeletal sarcoma suggests that MR is highly accurate for defining tumor margins preoperatively, guiding osteotomy cuts intraoperatively, and documenting recurrence or residual disease. Further evidence is necessary to evaluate the degree to which it can accurately guide osteotomy planning for resection of vertebral primaries.
脊柱原发性肉瘤每年影响约百万分之五的人群,其中半数至三分之一为恶性。这些病变的治疗需要多模式管理,通常要努力实现病变的切缘阴性切除。使用磁共振成像进行术前切缘规划可能有助于此,但目前关于使用这种成像准确预测计划手术切缘的文献尚缺。在此,我们回顾先前描述使用磁共振成像切除四肢肉瘤的研究,以确定可应用于脊柱肿瘤治疗的经验教训。我们对PubMed和EMBASE文献进行了系统回顾。纳入的研究描述了MRI在术前评估肿瘤切缘、术中切除指导或术后评估残留或复发性疾病方面的准确性。所有纳入研究均描述了接受四肢骨肉瘤或软组织肉瘤治疗的患者。我们找到1705篇独特参考文献,其中27篇符合纳入标准。七项研究报告称,MR对术前切缘评估的总体诊断准确率为93.6%至96%,非增强T1最能准确反映真实切缘。在九篇报告MR引导下切除结果的文章中,88.8%至100%的病例实现了切缘阴性,最接近切缘为2至4毫米。十一篇文章综合报告了MR对残留疾病或局部复发的准确性,残留疾病的平均敏感性和特异性分别为71.7%和79.3%,局部复发的平均敏感性和特异性分别为87.9%和85.9%。目前关于四肢肌肉骨骼肉瘤的文献表明,MR在术前定义肿瘤切缘、术中指导截骨以及记录复发或残留疾病方面高度准确。需要进一步的证据来评估其能在多大程度上准确指导椎体原发性肿瘤切除的截骨规划。