title: Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.
abstract: BACKGROUND
  Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role.
  
  
  METHODS
  The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence.
  
  
  RESULTS
  A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT.
  
  
  CONCLUSIONS
  The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, David St, Dandenong, Victoria, Australia.
authors.forename: Inoka
authors.initials: I
authors.lastname: De Silva
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Anand
authors.initials: A
authors.lastname: Ramakrishnan
authors.forename: Mansoor
authors.initials: M
authors.lastname: Mirkazemi
authors.forename: Charles
authors.initials: C
authors.lastname: Baillieu
authors.forename: Ronnie
authors.initials: R
authors.lastname: Ptasznik
authors.forename: James
authors.initials: J
authors.lastname: Leong
mesh_terms: D000564:Ameloblastoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D005629:Frozen Sections; D006651:Histocytochemistry; D006801:Humans; D007432:Intraoperative Period; D007573:Jaw Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult