A quantitative comparison of bone resection margin distances in virtual surgical planning versus histopathology: A prospective study.

Abstract

BACKGROUND\nMATERIALS AND METHODS\nRESULTS\nCONCLUSION\nPositive bone margins have been shown to be associated with worse locoregional control and survival performance in oral oncology patients. With the application of computer-assisted surgery (CAS) and patient-specific surgical guides, we can accurately execute the preoperative osteotomy plan. However, how well we can predict the margin distance in the final histopathology with a preoperative CT scan, the factors associated with it, and how much leeway we should spare when designing the osteotomy planes during virtual surgical planning remain to be investigated.\nPatients from Jan 2021 to Dec 2022 with benign or malignant jaw tumors and with signs of bone marrow involvement in the preoperative CT scan in our center were prospectively recruited to the study. Virtual surgical planning (VSP) and measurement of the closest margin distance in the CT scan were performed by the single team of surgeons. The resection specimen was processed, and the margin distances were measured by a dedicated senior pathologist with the knowledge of orientation of the osteotomy planes.\nA total of 35 patients were recruited, with 21 malignant and 14 benign cases. Sixty-eight bone margins were quantitatively analyzed. No significant difference in margin distances measured from the CT scan and final histopathology was detected (P=0.19), and there was a strong correlation between the two (rs=0.74, P<0.01). A considerable amount of variance was detected in the level of discrepancy between margin distances measured in CT scan and final histopathology (overall SD=6.26▓mm, malignancy SD=7.44▓mm, benign SD=4.40▓mm). No significant correlation existed between the two margin distances when only maxilla tumor margins were assessed (P=0.16).\nBone margin distance in VSP is reliably correlated to final pathological margin distance. A leeway distance of 15▓mm and 9▓mm should be considered when designing the osteotomy planes for malignancy and benign cases respectively. Extra attention should be paid to maxilla cases when pre-determining the osteotomy planes during virtual surgical planning.