Shoman Haitham, Al-Kassmy Jawad, Ejaz Maryam, Matta Justin, Alakhras Sandi, Kahla Kalin, D'Acunto Mario
Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada.
PhD - Vanier Scholar, Canadian Institute for Health Research, Ottawa, Canada.
J Bone Oncol. 2023 Feb 9;39:100469. doi: 10.1016/j.jbo.2023.100469. eCollection 2023 Apr.
Osteosarcoma is the most common malignant tumour of the bone. Complete surgical excision is critical to achieve optimal outcomes and lower recurrence rates. However, accurate assessment of tumour margins remains a challenge and multiple technologies are employed for this purpose. The aim of this study is to highlight current and emerging technologies and their efficacy in detecting clear bone margins intraoperatively, through a systematic review of the literature. The following databases were searched using the OVID platform: Medline, Embase, Global Health and Google Scholar. Studies were screened using predetermined eligibility criteria. Data was extracted based on study and patient characteristics, modes of detection, and commercial availability, followed by quality assessment. A total of 17 studies were included. The primary diagnosis varied, with osteosarcoma being reported by 9 studies. Three studies reported relapse, ranging between 17.6%-48%. Twelve studies reported non-invasive imaging as the mode of detection used, while 4 studies reported the use of frozen section. MRI and CT were found to have an accuracy of up to 93 %. Raman spectroscopy was reported to have an accuracy, sensitivity, and specificity of 69%, 58.8% and 83.3% respectively. CT had a sensitivity and specificity up to 83% and 100%, respectively. In conclusion, there seems to be high potential for the use of multimodal technologies to increase the accuracy of intraoperative margin assessment. Although imaging modalities possess a fair level of accuracy, they carry the risk of radiation exposure, are expensive, and cannot be used in-situ. Future clinical trials are needed to test the effectiveness of these technologies to measure the diagnostic accuracy and overall patient survival.
骨肉瘤是最常见的骨恶性肿瘤。完整的手术切除对于实现最佳治疗效果和降低复发率至关重要。然而，准确评估肿瘤切缘仍然是一项挑战，为此采用了多种技术。本研究的目的是通过对文献的系统回顾，突出当前和新兴技术及其在术中检测清晰骨切缘方面的功效。使用OVID平台检索了以下数据库：Medline、Embase、全球健康数据库和谷歌学术。根据预先确定的纳入标准对研究进行筛选。基于研究和患者特征、检测方式和商业可用性提取数据，随后进行质量评估。共纳入17项研究。主要诊断各不相同，9项研究报告为骨肉瘤。3项研究报告了复发情况，复发率在17.6%至48%之间。12项研究报告使用非侵入性成像作为检测方式，而4项研究报告使用冰冻切片。发现MRI和CT的准确率高达93%。据报道拉曼光谱的准确率、灵敏度和特异性分别为69%、58.8%和83.3%。CT的灵敏度和特异性分别高达83%和100%。总之，使用多模态技术提高术中切缘评估的准确性似乎具有很大潜力。尽管成像方式具有相当高的准确性，但它们存在辐射暴露风险，成本高昂，且不能在原位使用。需要未来的临床试验来测试这些技术测量诊断准确性和患者总体生存率的有效性。
