PAST
Surgical margin status is the most significant prognostic factor for patients with bone and soft tissue sarcoma.1 Musculoskeletal oncology specimens are often complex and contain various tissue types (skin, fascia, muscle, bone, cartilage). Currently, a telephone conversation without visual aid is the standard of care for pathologists to communicate the presence and location of a close or positive margin. Studies have shown that surgeons have difficulty relocating the positive margin site using current protocols due to complex three-dimensional (3D) anatomy. Improving upon this is important, as re-resection of positive margins improves patient outcomes.1
PRESENT
This study is unique for its use of ex vivo 3D scanning technologies in musculoskeletal oncology.2 Importantly, our protocol was able to visualize and distinguish between tissue types with high resolution. At our institution, surgeons and pathologists alike have found this protocol to enhance the quality of both intraoperative communication and provide valuable data for the postoperative final pathology report in patients with complex resection specimens.3
FUTURE
Currently, we are imaging pediatric specimens and assessing satisfaction among musculoskeletal oncology stakeholders of the new 3D specimen mapping protocol.4 In the future, we plan to investigate whether the 3D scanning and specimen mapping protocol can reduce positive margin rates and ultimately improve oncologic outcomes. We are also exploring an augmented reality protocol to register and align 3D holograms of specimen resections back into the surgical defect.5 This could allow surgeons to relocate the site of a positive margin and guide immediate re-resection more easily. In addition, we plan to 3D scan the surgical defect, which could allow for accurate annotation of supplemental margin resection sites. Finally, we plan to study the impact of 3D specimen maps on postoperative radiation therapy planning.
ACKNOWLEDGMENT
JMC is supported by the National Institute of General Medical Sciences (NIGMS) of the National Institutes of Health under award number T32GM007347. The content in this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
FUNDING
This work was supported by a Vanderbilt Clinical Oncology Research Career Development Program (K12 NCI 2K12CA090625-22A1) and an ACS Institutional Research Grant (#IRG-19-139-60).
Footnotes
DISCLOSURES Juan M. Colazo, Marina Aweeda, Carly Fassler, Reena Singh, Joshua M. Lawrenz, Ginger E. Holt, and Michael C. Topf have no conflicts of interest to disclose in relation to this current work.
REFERENCES
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