creating a virtual 3d specimen map of cancer resections to improve multidisciplinary care

Imagerie CAO avancée pour l’analyse chirurgicale des marges dans le traitement du cancer

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 &#62;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.
For head and neck surgeons to ensure complete oncologic resection while minimizing disruption of surrounding structures, intraoperative sampling of margins via frozen section analysis (FSA) is performed. FSA provides a rapid intraoperative pathology consultation that is widely used and is the standard of care5,6,7,8,9. Fresh tissue is frozen, thinly sliced, placed on a glass slide, and stained for immediate interpretation while the patient is still under anesthesia.
Head and neck oncologic specimens present several distinct challenges in accurately assessing margin status, including the anatomic complexity of head and neck cancer specimens, the minimal reserve in the head and neck region for wide excision given the proximity to vital structures such as the eyes, face, and important nerves and vasculature, and the multiple tissue types often present in the resected specimen (i.e., mucosa, cartilage, muscle, bone)10,11. Thus, a specimen-based approach to margin analysis requires an enhanced level of communication between surgeon and pathologist12. A face-to-face conversation is often warranted to ensure correct specimen orientation and discussion of concerning margins. However, this is not always safe or feasible as it requires either the surgeon to leave the operating room (OR) while the patient remains under general anesthesia or the pathologist to leave the gross pathology lab, interrupting their workflow. In addition, there may be a significant travel time between the OR and the pathology lab, or in some cases, the pathology lab may be off-site altogether.
Following FSA, the oncologic specimen is fixed in formalin and formally processed through inking, sectioning, and margin sampling. Slides are created and microscopically interpreted by the pathologist to create a final pathology report. For complex head and neck cancer resection, this can often take 1-2 weeks. Unfortunately, processing of the specimen commonly results in the destruction of the resected cancer specimen. This may create further confusion as the final pathology report, multidisciplinary tumor board discussions, adjuvant radiation therapy planning, and re-resection in the setting of positive margins, must all proceed without a visual record of the oncologic specimen and its pathologic processing.
To address this clinical unmet need, we have developed a 3D scanning and specimen mapping protocol to enhance communication between surgeons, pathologists, and other members of the multidisciplinary cancer care team.

Pleins feux sur l’auteur : La numérisation 3D et la réalité augmentée pour améliorer la communication en chirurgie du cancer

Communication améliorée des marges tumorales grâce à la numérisation et à la cartographie 3D

Création d’une carte virtuelle en 3D des résections de cancer pour améliorer les soins multidisciplinaires

Pour commencer, configurez le scanner 3D pour scanner la tumeur solide. Prenez l’échantillon oncologique réséqué et préparez-le pour l’examen. Une fois la numérisation 3D terminée, alignez la numérisation pour reproduire l’échantillon anatomique 3D et enregistrez les fichiers aux formats de fichier 3MF et OBJ.Une fois que l’échantillon est prêt à être traité, installez le poste de travail adjacent au membre de l’équipe de pathologie responsable de la macroscopie de l’échantillon. Disposez l’ordinateur portable et la souris externe sur le poste de travail. Ouvrez le logiciel de conception assistée par ordinateur à partir de l’ordinateur portable pour activer l’annotation virtuelle du modèle 3D.Cliquez sur le bouton Importer marqué d’une icône de signe plus et importez le fichier 3MF précédemment enregistré de la numérisation brute. Sélectionnez l’outil Pinceau pour définir une plage de tailles de 15 à 30. Utilisez la palette de couleurs pour faire correspondre les couleurs de peinture du logiciel avec les couleurs d’encre réelles sur le spécimen afin de délimiter les bordures de chaque région encrée.Ensuite, ajustez l’outil Pinceau sur un paramètre de taille de 35 à 45 et remplissez chaque section encrée avec la couleur appropriée. Consultez le prosecteur pour vérifier l’exactitude de tous les côtés encrés. Notez l’orientation anatomique de chaque côté encré pour l’inclusion dans la clé.

creating-virtual-3d-specimen-map-cancer-resections-to-improve

Research

JoVE Journal

Medicine

Creating a Virtual 3D Specimen Map of Cancer Resections to Improve Multidisciplinary Care

38 vues. Pour commencer, configurez le scanner 3D pour scanner la tumeur solide. Prenez l’échantillon oncologique réséqué et préparez-le pour l’examen. Une fois la numérisation 3D terminée, alignez la numérisation pour reproduire l’échantillon anatomique 3D et enregistrez les fichiers aux formats de fichier 3MF et OBJ.Une fois que l’échantillon est prêt à être traité, installez le poste de travail adjacent au membre de l’équipe de pathologie responsable de la macroscopi...

Vidéo: Création d’une carte virtuelle en 3D des résections de cancer pour améliorer les soins multidisciplinaires

Enhanced Communication of Tumor Margins Using 3D Scanning and Mapping

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.

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.

After oncologic resection of malignant tumors, specimens are sent to pathology for processing to determine the surgical margin status. These results are ...