Three-dimensional (3D) specimen mapping could be a more efficient and effective way to create pathology reports, according to a presentation at the Triological Society Combined Sections Meeting.
Explore This Issue
May 2024Researchers at Vanderbilt University Medical Center (VUMC) in Nashville have found that using 3D virtual models of resected cancer conveys information more effectively, while reducing the number of words that physicians have to read, said Carly Fassler, BS, a medical student research fellow at VUMC, who worked on the study with Michael Topf, MD, MSCI, an assistant professor of otolaryngology–head and neck surgery at Vanderbilt. If widely adopted, the method could represent a major improvement in how pathology reports are presented in head and neck and other types of cancer, she said.
“The current standard-of-care pathology report relies only on written descriptions of the main specimen as well as additional information contained in the synoptic report regarding tumor grade, stage, and margin status,” said Fassler. “This is used to communicate with the broader cancer care team, but it relies only on written text.”
On a slide, she showed an excerpt of a pathology report describing the main specimen and the summary of the sections used for the analysis. It was a somewhat forbidding block of text, totaling 506 words. And there’s a lot riding on that form of communication, she said.
“The written pathology report is typically the only remaining record of what the anatomic orientation of a surgical specimen looked like,” she said.
At Vanderbilt, researchers are developing a 3D virtual mapping protocol to improve communication between the surgeon and pathologist. To achieve this, the researchers use a commercially available 3D light scanner to scan fresh, ex vivo surgical specimens after resection. This takes their team an average of eight minutes. Then, the specimen is handed off to go through the normal pathology workflow, Fassler said. A member of the research team works alongside the prosector as they’re grossing the specimen and uses computer-aided design software to virtually annotate how the specimen is processed by the pathologist.
For the presented study, researchers chose 10 cases retrospectively from their repository of virtual 3D specimen maps that were created between June and December 2023. Cases were picked to emphasize a variety of anatomic subsites and to include those with closer or positive margins. The actual reports were created using PowerPoint with screen captures from the software, Fassler said.
All cases were of mucosal squamous cell carcinoma—six from subsites of the oral cavity, two from the oropharynx, and two from the larynx. All but one of the cases involved close or positive margins. The reports included information from the synoptic gross characteristics and a description of the tumor, plus measurements and a summary of the sections chosen for margin analysis, with screenshots of those sections. Color-coded arrows were used to quickly and visually point out margins of interest, such as those that were focally positive or close, Fassler said.
The written pathology report is typically the only remaining record of what the anatomic orientation of a surgical specimen looked like. — Carly Fassler, BS D