Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.

<h4>Background</h4>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 o...

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Autores principales:	Inoka De Silva, Warren M Rozen, Anand Ramakrishnan, Mansoor Mirkazemi, Charles Baillieu, Ronnie Ptasznik, James Leong
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/29f0be80947e456a881ce5419ed95002
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spelling	oai:doaj.org-article:29f0be80947e456a881ce5419ed950022021-11-18T08:11:27ZAchieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.1932-620310.1371/journal.pone.0047897https://doaj.org/article/29f0be80947e456a881ce5419ed950022012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23094099/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Method</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.Inoka De SilvaWarren M RozenAnand RamakrishnanMansoor MirkazemiCharles BaillieuRonnie PtasznikJames LeongPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 10, p e47897 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Inoka De Silva Warren M Rozen Anand Ramakrishnan Mansoor Mirkazemi Charles Baillieu Ronnie Ptasznik James Leong Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.
description	<h4>Background</h4>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.<h4>Method</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
format	article
author	Inoka De Silva Warren M Rozen Anand Ramakrishnan Mansoor Mirkazemi Charles Baillieu Ronnie Ptasznik James Leong
author_facet	Inoka De Silva Warren M Rozen Anand Ramakrishnan Mansoor Mirkazemi Charles Baillieu Ronnie Ptasznik James Leong
author_sort	Inoka De Silva
title	Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.
title_short	Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.
title_full	Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.
title_fullStr	Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.
title_full_unstemmed	Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.
title_sort	achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. clinical report and systematic review.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/29f0be80947e456a881ce5419ed95002
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Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.

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