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Novel imaging techniques for intraoperative margin assessment in surgical oncology: A systematic review
Jan Heidkamp1, Mirre Scholte2, Camiel Rosman3
1Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract:
Inadequate margins continue to occur frequently in patients who undergo surgical resection of a tumor, suggesting that current intraoperative methods are not sufficiently reliable in determining the margin status. This clinical demand has inspired the development of many novel imaging techniques that could help surgeons with intraoperative margin assessment. This systematic review provides an overview of novel imaging techniques for intraoperative margin assessment in surgical oncology, and reports on their technical properties, feasibility in clinical practice and diagnostic accuracy. PubMed, Embase, Web of Science and the Cochrane library were systematically searched (2013-2018) for studies reporting on imaging techniques for intraoperative margin assessment. Patient and study characteristics, technical properties, feasibility characteristics and diagnostic accuracy were extracted. This systematic review identified 134 studies that investigated and developed 16 groups of techniques for intraoperative margin assessment: fluorescence, advanced microscopy, ultrasound, specimen radiography, optical coherence tomography, magnetic resonance imaging, elastic scattering spectroscopy, bio-impedance, X-ray computed tomography, mass spectrometry, Raman spectroscopy, nuclear medicine imaging, terahertz imaging, photoacoustic imaging, hyperspectral imaging and pH measurement. Most studies were in early developmental stages (IDEAL 1 or 2a, n = 98); high-quality stage 2b and 3 studies were rare. None of the techniques was found to be clearly superior in demonstrating high feasibility as well as high diagnostic accuracy. In conclusion, the field of imaging techniques for intraoperative margin assessment is highly evolving. This review provides a unique overview of the opportunities and limitations of the currently available imaging techniques.
Insights
Novel imaging techniques for intraoperative margin assessment in surgical oncology are rapidly evolving. However, no single technique currently demonstrates superior feasibility and diagnostic accuracy for reliable tumor margin evaluation.
Area of Science:
- Surgical Oncology
- Medical Imaging
- Diagnostic Technology
Background:
- Inadequate surgical tumor margins remain a significant clinical challenge, leading to positive margins and potential cancer recurrence.
- Current intraoperative methods for assessing tumor margins lack sufficient reliability, necessitating improved diagnostic tools.
Purpose of the Study:
- To systematically review novel imaging techniques for intraoperative margin assessment in surgical oncology.
- To report on the technical properties, clinical feasibility, and diagnostic accuracy of these emerging technologies.
Main Methods:
- A systematic literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library (2013-2018).
- Studies reporting on imaging techniques for intraoperative margin assessment were included, extracting patient/study characteristics, technical/feasibility data, and diagnostic accuracy.
Main Results:
- 134 studies investigated 16 groups of techniques, including fluorescence, advanced microscopy, ultrasound, and advanced imaging modalities.
- Most studies were in early developmental stages (IDEAL 1 or 2a); high-quality evidence (IDEAL 2b/3) was scarce.
- No single technique emerged as clearly superior in both feasibility and diagnostic accuracy.
Conclusions:
- The field of intraoperative imaging for margin assessment is dynamic and rapidly advancing.
- This review offers a comprehensive overview of the opportunities and limitations of current techniques.
- Further high-quality research is needed to validate promising technologies for clinical application.
