我们偏离多远了？分析头颈部手术切缘重定位的准确性。
How far are we off? Analyzing the accuracy of surgical margin relocation in the head and neck.
机构信息
Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
出版信息
Head Neck. 2024 Nov;46(11):2709-2716. doi: 10.1002/hed.27793. Epub 2024 May 4.
BACKGROUND
Positive surgical margin rates remain high in head and neck cancer surgery. Relocation is challenging given the complex, three-dimensional (3D) anatomy.
METHODS
Prospective, multi-institutional study to determine accuracy of head and neck surgeons and pathologists relocating margins on virtual 3D specimen models using written descriptions from pathology reports. Using 3D models of 10 head and neck surgical specimens, each participant relocated 20 mucosal margins (10 perpendicular, 10 shave).
RESULTS
A total of 32 participants, 23 surgeons and 9 pathologists, marked 640 margins. Of the 320 marked perpendicular margins, 49.7% were greater than 1 centimeter from the true margin with a mean relocation error of 10.2 mm. Marked shave margins overlapped with the true margin a mean 54% of the time, with no overlap in 44 of 320 (13.8%) shave margins.
CONCLUSIONS
Surgical margin relocation is imprecise and challenging even for experienced surgeons and pathologists. New communication technologies are needed.
背景
头颈部癌症手术中的阳性切缘率仍然很高。由于解剖结构复杂，呈三维（3D）形态，因此重新定位非常具有挑战性。
方法
前瞻性、多机构研究，旨在确定头颈部外科医生和病理学家根据病理报告中的书面描述，在虚拟 3D 标本模型上重新定位切缘的准确性。使用 10 个头颈部手术标本的 3D 模型，每个参与者重新定位 20 个黏膜切缘（10 个垂直，10 个平切）。
结果
共有 32 名参与者，包括 23 名外科医生和 9 名病理学家，标记了 640 个切缘。在标记的 320 个垂直切缘中，有 49.7%大于 1 厘米，平均重新定位误差为 10.2 毫米。标记的平切切缘与真实切缘平均重叠 54%，在 320 个平切切缘中有 44 个（13.8%）没有重叠。
结论
即使对于经验丰富的外科医生和病理学家来说，手术切缘的重新定位也是不准确和具有挑战性的。需要新的沟通技术。
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