Garset-Zamani Martin, Makouei Fatemeh, Agander Tina K, Lelkaitis Giedrius, Charabi Birgitte W, Tvedskov Jesper F, Rubek Niclas, Lomholt Anne F, Frehr Theresa D, Norling Rikke, Buchwald Christian von, Todsen Tobias
Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital - Rigshospitalet, 2100 Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen 2200 Copenhagen, Denmark.
Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital - Rigshospitalet, 2100 Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen 2200 Copenhagen, Denmark.
Oral Oncol. 2025 Jun;165:107330. doi: 10.1016/j.oraloncology.2025.107330. Epub 2025 Apr 29.
Close margins after transoral robotic surgery (TORS) in oropharyngeal squamous cell carcinoma (OPSCC) are common due to narrow anatomical boundaries, requiring additional radiotherapy treatment (RT). Ultrasound (US) can be used intraoperatively to distinguish tumors from healthy tissue. Our objective was to explore ex vivo US of surgical specimens from OPSCCs using a novel 3D US method to correlate tumor and margin measurements with histopathology.
Patients with OPSCC undergoing TORS either primarily or as salvage surgery were included. Ex vivo US was performed immediately after resection in the operation room and 3D US models were obtained. The US images were then analyzed by four surgeons blinded to histopathology for correlation analyses. The accuracy to classify close or free margins using a 2 mm threshold was computed.
Nine patients with OPSCC were included (median age 63 years, six males, five with previous RT, and five were Human Papillomavirus-positive). US and histopathology had a high correlation for tumor (r = 0.84-0.85) and margin measurements (r = 0.76-0.78). US measured deep margins with a mean difference of 0.5 mm (SD: 1.2 mm) compared to histopathology and had 80% sensitivity to detect areas of the surgical specimens with close margins (<2 mm). US correctly categorized the deep margin status in 89% of the surgical specimens, compared to 44% for the lateral margins.
This proof-of-concept study shows that ex vivo 3D US is feasible for intraoperative evaluation of deep surgical margins during TORS of OPSCCs.
由于解剖边界狭窄，口咽鳞状细胞癌（OPSCC）经口机器人手术（TORS）后切缘接近的情况很常见，这需要额外的放射治疗（RT）。超声（US）可在术中用于区分肿瘤与健康组织。我们的目的是使用一种新型三维超声方法探索OPSCC手术标本的离体超声，以将肿瘤和切缘测量结果与组织病理学相关联。
纳入接受TORS治疗的原发性或挽救性手术的OPSCC患者。在手术室切除后立即进行离体超声检查，并获得三维超声模型。然后由四名对组织病理学不知情的外科医生分析超声图像以进行相关性分析。计算使用2毫米阈值对切缘接近或切缘阴性进行分类的准确性。
纳入9例OPSCC患者（中位年龄63岁，6例男性，5例曾接受过放疗，5例人乳头瘤病毒阳性）。超声与组织病理学在肿瘤（r = 0.84 - 0.85）和切缘测量（r = 0.76 - 0.78）方面具有高度相关性。与组织病理学相比，超声测量深部切缘的平均差异为0.5毫米（标准差：1.2毫米），并且在检测切缘接近（<2毫米）的手术标本区域方面具有80%的敏感性。超声在89%的手术标本中正确分类了深部切缘状态，而外侧切缘的正确分类率为44%。
这项概念验证研究表明，离体三维超声对于OPSCC的TORS术中深部手术切缘评估是可行的。
