背景:精准手术在骨科肿瘤学领域变得越来越重要。图像引导经皮冷冻手术(CRA)已成为腹外硬纤维瘤(EDT)的有效治疗方式。迄今为止,大多数CRA程序使用基于CT的指导,无法正确表征肿瘤节段。然而,计算机引导的MRI导航可以解决这个问题,缺乏固定的注册地标仍然是一个挑战。成功的CRA与术中成像指导促进的精确方法直接相关。这是第一项尝试评估使用皮肤基准标记来克服基于MRI的导航CRA用于有症状或进行性EDT的挑战的新方法的可行性和有效性的研究。
方法:在2018年至2020年进行的这项回顾性研究中,使用术中MRI导航对单个中心有症状或进行性EDT的11例患者进行了CRA治疗。进行了15次冷冻手术,每个人都坚持个性化的术前计划。肿瘤总大小,手术前和手术后可行和不可行部分,记录评价主观健康状况的SF-36问卷。
结果:所有CRA均表现出对预定计划的100%依从性。总的来说,肿瘤大小减小,中位数=-56.9%[-25.6,-72.4]),活组织减少,(中位数=-80.4%[-53.3,-95.2])。四名患者需要额外的CRA。只有一名患者的肿瘤没有缩小。1例患者出现局部肌肉坏死。操作前,平均身体和心理得分分别为41.6[29.4,43]和26.3[17.6,40.9]。手术后,平均身心得分分别为53.4[38,59.7]和38[31.2,52.7]。
结论:这些发现为使用皮肤基准标记配准进行经皮冷冻手术的可行性和有效性提供了早期指示,用于MRI计算机导航以安全地治疗EDT。需要更大的队列和多中心评估来确定该技术的功效。
BACKGROUND: Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This is the first study that attempts to assess the feasibility and efficacy of a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs.
METHODS: In this retrospective study conducted between 2018 and 2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded.
RESULTS: All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased Median= -56.9% [-25.6, -72.4]) with a reduction in viable tissue, (Median= -80.4% [-53.3, -95.2]). Four patients required additional CRAs. Only one patient\'s tumor did not reduce in size. One patient suffered from local muscle necrosis. Pre-operation, the average physical and mental scores 41.6 [29.4, 43] and 26.3 [17.6, 40.9] respectively. Post-operation, the average physical and mental scores were 53.4[38, 59.7] and 38 [31.2, 52.7] respectively.
CONCLUSIONS: These findings provide an early indication of the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration for MRI-computed navigation to treat EDTs safely. Larger cohorts and multicenter evaluations are needed to determine the efficacy of this technique.