In vivo and ex vivo sonographic evaluation of tumor margins during micrographic-controlled surgery: a promising new tool in dermato-oncology?

Abstract

Background and objectives: The current research examined the In vivo and ex vivo use of high-frequency ultrasound (HFUS) during micrographic-controlled surgery (MCS) of non-melanoma skin cancer (NMSC) of the head-and-face area, particularly the perioperative surgical margin assessment for potential reduction in surgical steps and patients' hospitalization time.

Patients and methods: Pre-operative in vivo and ex vivo sonographies of 136 NMSCs from 111 patients were evaluated retrospectively for tumor margin assessment during MCS by an experienced dermatosurgeon, while the specimens were independently assessed by a histopathologist.

Results: Our ex-vivo tumor margin assessment showed a specificity of >98% for squamous cell and basal cell carcinoma, with only five false-negative and two false-positive results, when compared to histopathology. HFUS correctly identified tumor-free margins in 89% of investigated lesions after first resection, as well as eight incomplete excisions (6%) in which a re-excision was performed and tumor residues were detected histologically. Overall, HFUS showed a very high accuracy in detecting both cancer-free margins and remaining tumor residues.

Conclusions: HFUS is a highly accurate method for rapidly assessing tumor margins during MCS of NMSC of highly esthetic areas, having the potential to significantly reduce surgical steps and hospitalization time in dermatosurgical patients, improving the quality of healthcare.