Visual pathology reports for communication of final margin status in laryngeal cancer surgery

Abstract

Background: Positive margins are frequently observed in total laryngectomy (TL) specimens. Effective communication of margin sampling sites and final margin status between surgeons and pathologists is crucial. In this study, we evaluate the utility of multimedia visual pathology reports to facilitate interdisciplinary discussion of margin status in laryngeal cancer surgery.

Methods: Ex vivo laryngeal cancer surgical specimens were three-dimensional (3D) scanned before standard of care pathological analysis. Using computer-aided design software, the 3D model was annotated to reflect inking, sectioning, and margin sampling sites, generating a visual pathology report. These reports were distributed to head and neck surgeons and pathologists postoperatively.

Results: Fifteen laryngeal cancer surgical specimens were 3D scanned and virtually annotated from January 2022 to December 2023. Most specimens (73.3%) were squamous cell carcinomas (SCCs). Among the cases, 26.7% had final positive surgical margins, whereas 13.3% had close margins, defined as <5 mm. The visual pathology report demonstrated sites of close or positive margins on the 3D specimens and was used to facilitate postoperative communication between surgeons and pathologists in 85.7% of these cases. Visual pathology reports were presented in multidisciplinary tumor board discussions (20%), email correspondences (13.3%), and teleconferences (6.7%), and were referenced in the final written pathology reports (26.7%).

Conclusions: 3D scanning and virtual annotation of laryngeal cancer specimens for the creation of visual pathology reports is an innovative approach for postoperative pathology documentation, margin analysis, and surgeon-pathologist communication.

Keywords: 3D scanning; Head and neck cancer; Surgical margins; Surgical pathology.

Fig. 1

Multimedia visual pathology report created and shared via email with head and neck surgeons and pathologists for Case #13: a total laryngectomy, partial pharyngectomy, and right thyroidectomy specimen with final positive margins.

Fig. 2

Visual pathology report presented during multidisciplinary tumor board for Case #11, a pT4aN0 supraglottic squamous cell carcinoma total laryngectomy specimen with close final margins. Representatives from head and neck surgery, pathology, radiology, medical oncology, and radiation oncology were present to discuss margin status and recommendations for adjuvant therapy.

Fig. 3

Three-dimensional (3D) images of the posterior (A) and right (B) aspects of a total laryngectomy specimen for Case #13, Illustrative Case #1. Inlayed two-dimensional (2D) images (hematoxylin and eosin, H&E), corresponding to the alphabetic gross tissue cassettes, highlight sampling site “N” where the tumor is close (2 mm) to the inked margin, but negative (4× magnification, top-right). A nearby separate section, “O,” showed tumor focally present at the inked surface, constituting a positive margin (20× magnification, bottom-right).

Fig. 4

Visual pathology report discussed by surgeon and pathologist using Microsoft Teams teleconference for Case #13, Illustrative Case #1. The three-dimensional (3D) total laryngectomy specimen is presented within the computer-aided design software in the center of the image. A member of the research team rotates the virtual 3D specimen as the surgeon and pathologist discuss sites of close and positive margins.

Fig. 5

A. Two-dimensional picture of fresh surgical specimen. B. Three-dimensional (3D) model of surgical specimen after 3D scanning. C. 3D model after virtual annotation using computer-aided design.

Fig. 6

Three-dimensional (3D) images of the inferior posterior aspect of a total laryngectomy specimen corresponding with Case #14, Illustrative Case #2. Yellow rectangles highlight anterior margin sampling sites “P” and “R.” Inlayed two-dimensional (2D) images (hematoxylin and eosin, H&E), show the tumor abutting the blue-inked left margin (left image, 10× magnification) and black-inked right margin (right image, 20× magnification). Thermal effect on the tissue is present at the inked surface, further supporting the reported positive margin status. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)