Intraoperative control of resection margins in advanced head and neck cancer using a 3D-navigation system based on PET/CT image fusion

Feichtinger, Matthias; Pau, Mauro; Zemann, Wolfgang; Aigner, Reingard Maria; Kärcher, Hans

doi:10.1016/j.jcms.2010.02.004

« Previous Next »Journal of Cranio-Maxillo-Facial Surgery
Volume 38, Issue 8 , Pages 589-594, December 2010

Intraoperative control of resection margins in advanced head and neck cancer using a 3D-navigation system based on PET/CT image fusion

Matthias Feichtinger, MD, DMD (Consultant)
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Austria
Mauro Pau, MD (Consultant)
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Austria
- Dr. Mauro PAU, MD Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 7, A-8036 Graz, Austria. Tel.: +43 316 385 2565; Fax: +43 316 385 3511.
Wolfgang Zemann, MD, DMD (Consultant)
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Austria
Reingard Maria Aigner, MD, PhD (Professor, Head)
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, Austria
Hans Kärcher, MD, PhD (Professor, Head)
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, Austria

Received 17 September 2009; accepted 5 February 2010. published online 09 April 2010.

Summary

Local recurrent of disease in advanced carcinomas of the head and neck is strongly correlated with the presence of positive or close resection margins after operative treatment. The purpose of this study is to present a new method of assessing resection margins intraoperatively using image-guided surgery based on positron emission tomography/computed tomography (PET/CT) image fusion.

In 6 patients who underwent surgical treatment of head and neck stage for T4a–T4b carcinomas PET/CT image fusion was done on the workstation of a 3D-navigation system. Intraoperative image-guided navigation of the defect following surgical ablation of the tumour was performed in every patient.

Intraoperative navigation of the ablative defect showed an unsafe resection margin in 4 patients.

In three of these patients additional image-guided resection allowed local control of the tumour to be achieved. In one patient additional resection was not possible due to skull base invasion. The histopathological exam of the four tumour specimens confirmed positive or close resection margins.

The current results suggest that intraoperative control of the surgical margins using a 3D-navigation system based on PET/CT image fusion can be a useful tool to assess and improve local control in advanced cancer of the head and neck.

Keywords: PET/CT, image-guided surgery, resection margins, advanced head and neck cancer