Giannitto Caterina, Mercante Giuseppe, Disconzi Luca, Boroni Riccardo, Casiraghi Elena, Canzano Federica, Cerasuolo Michele, Gaino Francesca, De Virgilio Armando, Fiamengo Barbara, Ferreli Fabio, Esposito Andrea Alessandro, Oliva Paolo, Ronzoni Flavio, Terracciano Luigi, Spriano Giuseppe, Balzarini Luca
Department of Diagnostic Radiology, Humanitas Clinical and Research Center Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.
Otorhinolaryngology Unit, Humanitas Clinical and Research Centre Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.
Front Oncol. 2021 Dec 9;11:735002. doi: 10.3389/fonc.2021.735002. eCollection 2021.
A surgical margin is the apparently healthy tissue around a tumor which has been removed. In oral cavity carcinoma, a negative margin is considered ≥ 5 mm, a close margin between 1 and 5 mm, and a positive margin ≤ 1 mm. Currently, the intraoperative surgical margin status is based on the visual inspection and tissue palpation by the surgeon and intraoperative histopathological assessment of the resection margins by frozen section analysis (FSA). FSA technique is limited and susceptible to sampling errors. Definitive information on the deep resection margins requires postoperative histopathological analysis.
We described a novel approach for the assessment of intraoperative surgical margins by examining a surgical specimen oriented through a 3D-printed specific patient tongue with real-time Magnetic Resonance Imaging (MRI). We reported the preliminary results of a case series of 10 patients, prospectively enrolled, with oral tongue carcinoma who underwent surgery between February 2020 and April 2021. Two radiologists with 5 and 10 years of experience, respectively, in Head and Neck radiology in consensus evaluated specimen MRI and measured the distance between the tumor and the specimen surface. We performed intraoperative bedside FSA. To compare the performance of bedside FSA and MRI in predicting definitive margin status we computed the weighted sensitivity (SE), specificity (SP), accuracy (ACC), area under the ROC curve (AUC), F1-score, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). To express the concordance between FSA and MRI we reported the jaccard index.
Intraoperative bedside FSA showed SE of 90%, SP of 100%, F1 of 95%, ACC of 0.9%, PPV of 100%, NPV (not a number), and jaccard of 90%, and MRI showed SE of 100%, SP of 100%, F1 of 100%, ACC of 100%, PPV of 100%, NPV of 100%, and jaccard of 100%. These results needed to be validated in a larger sample size of 21- 44 patients.
The presented method allows a more accurate evaluation of surgical margin status, and the first clinical experiences underline the high potential of integrating FSA with MRI of the fresh surgical specimen.
手术切缘是指已切除肿瘤周围外观正常的组织。在口腔癌中，阴性切缘被认为≥5毫米，切缘接近为1至5毫米，阳性切缘≤1毫米。目前，术中手术切缘状态基于外科医生的视觉检查和组织触诊以及通过冰冻切片分析（FSA）对切除边缘进行术中组织病理学评估。FSA技术存在局限性且易受抽样误差影响。关于深部切除边缘的确切信息需要术后组织病理学分析。
我们描述了一种通过使用实时磁共振成像（MRI）检查经3D打印的特定患者舌头定向的手术标本，来评估术中手术切缘的新方法。我们报告了2020年2月至2021年4月期间前瞻性纳入的10例接受手术的口腔舌癌患者病例系列的初步结果。两名分别具有5年和10年头颈放射学经验的放射科医生一致评估标本MRI并测量肿瘤与标本表面之间的距离。我们进行了术中床边FSA。为了比较床边FSA和MRI在预测最终切缘状态方面的性能，我们计算了加权灵敏度（SE）、特异性（SP）、准确性（ACC）、ROC曲线下面积（AUC）、F1分数、阳性预测值（PPV）和阴性预测值（NPV）。为了表示FSA和MRI之间的一致性，我们报告了杰卡德指数。
术中床边FSA显示灵敏度为90%，特异性为100%，F1为95%，准确性为0.9%，阳性预测值为100%，阴性预测值（非数字），杰卡德指数为90%，而MRI显示灵敏度为100%，特异性为100%，F1为100%，准确性为100%，阳性预测值为100%，阴性预测值为100%，杰卡德指数为100%。这些结果需要在21至44例患者的更大样本量中进行验证。
所提出的方法能够更准确地评估手术切缘状态，并且首批临床经验突显了将FSA与新鲜手术标本的MRI相结合的巨大潜力。
