Intra-operative Assessment of Surgical Margins

Background

Surgery is the mainstay of treatment for many patients with solid cancers. The intention of this treatment is to achieve complete removal of the malignancy with tumour-free resection margins. Failure to achieve tumour-free resection margins is often associated with higher local recurrence rates. Therefore, inadequate margins are often an indication for re-resection or adjuvant (chemo) radiotherapy contributing to morbidity and reduction in quality of life of the patients that are face with these treatments.


Currently, visual inspection and palpation are the only methods that can be intraoperatively employed by the surgeon to verify the surgical margin status. These methods, however, do not prove to be reliable given the high incidence rates of inadequate resection margins after oncologic surgery. The role of intraoperative histopathological assessment of the surgical margin status by frozen section analysis has been investigated as a method to address this problem, but the method demonstrated limited diagnostic value.


MRI has the ability to provide excellent soft-tissue contrast and 3D volumetric information and we therefore hypothesize that the acquisition an intraoperative MRI of the resection specimen could provide the surgeon with the necessary information about the surgical margins status. The ultimate goal is that the surgeon is able to intraoperatively direct an additional resection based on this information.


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Project

Within the scope of this project, several fresh resected tumor specimens obtained from the prostate, tongue, and vulva will be imaged by MRI. The images will be radiologically evaluated for their diagnostic accuracy to predict tumour-free resection margins compared to whole-mount histopathological evaluation as the gold standard. A systematic review will be conducted as well to investigate which imaging techniques are currently investigated as methods to provide intraoperative surgical margin status information.

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