Achieving Adequate Margins in Ameloblastoma Resection: The Role for Intra-Operative Specimen Imaging. Clinical Report and Systematic Review

• Published in: PloS one Vol. 7; no. 10; p. e47897
• Main Authors: De Silva, Inoka, Rozen, Warren M., Ramakrishnan, Anand, Mirkazemi, Mansoor, Baillieu, Charles, Ptasznik, Ronnie, Leong, James
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.10.2012; Public Library of Science (PLoS)
• Subjects: Accuracy; Ameloblastoma; Ameloblastoma - diagnostic imaging; Ameloblastoma - pathology; Ameloblastoma - surgery; Biology; Care and treatment; CAT scans; Comparative studies; Computed tomography; Excision (Surgery); Female; Frozen Sections; Histocytochemistry; Histology; Hospitals; Humans; Imaging; Intraoperative Period; Jaw Neoplasms - diagnostic imaging; Jaw Neoplasms - pathology; Jaw Neoplasms - surgery; Medical imaging; Medicine; Mouth cancer; Neoplasm Recurrence, Local - prevention & control; NMR; Nuclear magnetic resonance; Plastic surgery; Radiography; Surgery; Surgery, Computer-Assisted - methods; Systematic review; Tomography, X-Ray Computed - methods; X-rays; Young Adult; Australia; Victoria Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0047897

Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection.