At the same time, very radical approaches are considered undesirable in many organs because of related morbidity, loss of function and esthetics.Īchieving adequate resection margins is a critical element of surgical oncology, as inadequate resection margins are associated with increased recurrence rates and poorer survival.įurthermore, inadequate margins put patients at risk of undergoing additional therapy, that is, re‐resection or adjuvant (chemo) radiotherapy, which is associated with increased morbidity, reduced quality of life and costs.ĭespite the burden on patients and the healthcare system, inadequate margins continue to occur frequently in around 5% of resections of lung The objective of surgical oncology is complete resection of the tumor with adequate, that is, clear, margins. Surgical resection remains the cornerstone of therapy for patients with primary solid tumors. This review provides a unique overview of the opportunities and limitations of the currently available imaging techniques. In conclusion, the field of imaging techniques for intraoperative margin assessment is highly evolving. None of the techniques was found to be clearly superior in demonstrating high feasibility as well as high diagnostic accuracy. Most studies were in early developmental stages (IDEAL 1 or 2a, n = 98) high‐quality stage 2b and 3 studies were rare. 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. Patient and study characteristics, technical properties, feasibility characteristics and diagnostic accuracy were extracted. PubMed, Embase, Web of Science and the Cochrane library were systematically searched (2013‐2018) for studies reporting on imaging techniques for 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.
This clinical demand has inspired the development of many novel imaging techniques that could help surgeons with intraoperative margin assessment.
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.
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