MarginView3D: Extending Novel 3D Surgical Pathology Reporting for Use in Invasive pT4 Thyroid Cancer and Other Surgical Oncologic Procedures.

[BACKGROUND] The American Thyroid Association's most recent clinical practice guidelines include margin status as a key factor to estimate risk of recurrence. Unlike most thyroid cancers, the successful resection of invasive pT4 thyroid cancers necessitates the use of frozen section analysis (FSA). There is no standardized method for intraoperative surgical margin assessment. We developed a novel intraoperative workflow and software platform, MarginView3D (MV3D), to enhance the precision of FSA and improve surgical pathology reporting in head and neck cancer. Here, we demonstrate its use in invasive thyroid cancer.

[METHODS] We describe the MV3D surgical pathology reporting software and detail our surgical workflow, which incorporates 3D scanning technology and standardized "timeouts" to facilitate intraoperative communication and pathologic documentation. This approach was utilized in five invasive pT4 thyroid cancer cases.

[RESULTS] MV3D was used to guide intraoperative margin assessment, communication, and pathologic documentation in four tracheal resections and one sternal mass resection. A final surgical pathology report was generated for each case, integrating 3D scans, annotated radiographs, and audiovisual summaries into a dynamic interface for multidisciplinary use. We highlight case 5, where MV3D facilitated bidirectional communication between the surgeon and pathologist to guide precise harvesting of supplemental margins. The surgeon and pathologist collaborated in real time to address at-risk areas requiring immediate re-resection. An R0 resection was achieved, and all relevant details were captured within MV3D.

[CONCLUSIONS] We have utilized our novel approach extensively in head and neck cancer. Here, we highlight it as a tool for the management of invasive pT4 thyroid cancer. As a brief summary of new and innovative research, this study introduces MV3D as a novel and scalable approach to intraoperative margin assessment and documentation in advanced thyroid cancer, with the potential to inform future practice in surgical oncology.