Enhanced Communication of Tumor Margins Using 3D Scanning and Mapping

Summary

A novel method for 3D scanning and virtual mapping of cancer resections is proposed with the goal of improving communication among the multidisciplinary cancer care team.

Abstract

After oncologic resection of malignant tumors, specimens are sent to pathology for processing to determine the surgical margin status. These results are communicated in the form of a written pathology report. The current standard-of-care pathology report provides a written description of the specimen and the sites of margin sampling without any visual representation of the resected tissue. The specimen itself is typically destroyed during sectioning and analysis. This often leads to challenging communication between pathologists and surgeons when the final pathology report is confirmed. Furthermore, surgeons and pathologists are the only members of the multidisciplinary cancer care team to visualize the resected cancer specimen. We have developed a 3D scanning and specimen mapping protocol to address this unmet need. Computer-aided design (CAD) software is used to annotate the virtual specimen clearly showing sites of inking and margin sampling. This map can be utilized by various members of the multidisciplinary cancer care team.

Introduction

The goal of oncologic resection is the complete removal of cancer with surgical margins microscopically clear of tumor cells. In head and neck cancer, the surgical margin status is the most important pathologic risk factor¹. A positive surgical margin increases the risk of 5-year local recurrence and all-cause mortality by >90%². Despite advances in medical technology and surgical techniques in recent years, positive margin rates in head and neck cancer remain high³. For locally advanced oral cavity cancers, the positive margin rate within the United States is 18.1%⁴.

Protocol

This protocol was performed at Vanderbilt University Medical Center under IRB#221597. Patients provided written consent for ex vivo 3D scanning and digital mapping of their surgical specimen prior to surgery and the addition of their scan to a 3D specimen model biorepository. Inclusion criteria were patients 18 and older with a suspected or biopsy-proven head and neck neoplasm undergoing surgical resection. 3D specimen maps were created based on surgeon and pathologist preference and staff availability.

Discussion

Traditionally, there is no visual representation of a resected cancer specimen. Pathologic processing often destroys the specimen. Prior work has demonstrated the feasibility and utility of 3D scanning of oncologic specimens followed by virtual annotation of the models to create 3D specimen maps which are representative of pathologic processing^13,14,15. This provides the multidisciplinary care team with a visual model of the ana.......

Materials

Name	Company	Catalog Number	Comments
Computer Aided Design Software	MeshMixer		Virtual annotation software for 3D models
Digital Camera or Cameraphone	iPhone		May use iPhone camera or any digital camera available
EinScan SP V2 Platinum Desktop 3D Scanner	Shining 3D		3D scanner hardware
ExScan Software; Solid Edge SHINING 3D Edition	Shining 3D		3D capture software included with purchase of 3D Scanner
External Mouse	Microsoft
Laptop Computer	Dell XP5	00355-60734-40310-AAOEM	Laptop Requirements: USB: 1 ×USB 2.0 or 3.0; OS: Win 7, 8 or 10 (64 bit); Graphic Card: Nvidia series; Graphic memory: >1 G; CPU: Dual-core i5 or higher; Memory: >8 G
Microsoft Office Suite	Microsoft
Mobile Presentation Cart	Oklahoma Sound	PRC450
PowerPoint Software	Microsoft Office		Presentation software
Sit-Stand Mobile Desk Cart	Seville Classics
USB-c Device Converter	TRIPP-LITE	U442-DOCK3-B	Necessary only if laptop does not have USB