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Margin Assessment in Renal Surgery Using a Handheld Optical Coherence Tomography Probe.
Wesley W Ludwig1, Sara E Wobker2, Mark W Ball1
1The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
Urology
|December 3, 2017
Summary
Handheld optical coherence tomography (OCT) accurately assessed surgical margins during partial nephrectomy (PN) ex vivo. This technology shows promise in reducing the need for frozen sections and minimizing tissue removal.
Area of Science:
- Urology
- Surgical Oncology
- Medical Imaging
Background:
- Accurate assessment of surgical margins is critical in partial nephrectomy (PN) to ensure complete tumor removal.
- Intraoperative margin evaluation often relies on frozen section analysis, which can be time-consuming and may not always be definitive.
Purpose of the Study:
- To evaluate the feasibility and accuracy of a handheld optical coherence tomography (OCT) probe for intraoperative surgical margin assessment during PN.
- To determine if OCT can reliably differentiate between positive and negative margins in kidney tumor specimens.
Main Methods:
- A feasibility study involved sectioning a radical nephrectomy specimen with known gross margin widths (0, 1, and 2 mm).
- Optical coherence tomography (OCT) was used to measure margin widths in these sections.
- A prospective ex vivo study assessed 15 PN tumor specimens using OCT to determine margin status and measure tissue attenuation coefficients.
Main Results:
- OCT measurements closely correlated with gross margin widths, with statistically significant differences between groups (P < .04).
- The sensitivity and specificity of OCT for identifying positive margins were both 100%.
- In ex vivo PN specimens, OCT accurately identified all negative margins.
Conclusions:
- Handheld OCT is a feasible tool for ex vivo assessment of surgical margins in PN.
- OCT has the potential to reduce the reliance on intraoperative frozen sections.
- This technology may help surgeons minimize parenchymal excision while ensuring oncologic safety.
