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Ep. 378 Setting the Benchmark: Ablation Confirmation Software for Tumors with Dr. Bruno Odisio and Dr. Constantinos Sofocleous

BackTable Vascular & Interventional

NOTE

The Importance of Margin Confirmation in Clinical Practice

Margin confirmation is important in clinical practice for achieving local tumor control. The use of 3D confirmation has been shown to correlate with tumor control and recurrence. However, determining the optimal margin size is challenging due to the variability in image input. It is still unknown whether a 5mm, 10mm, or 3mm margin is suboptimal. Standard deviation of measurement below 5mm is unreliable.

00:00
Speaker 3
All right, so let's talk a little bit more now, specifically about margin confirmation. And I think, Costa, you already made the case about it's sort of intuitively obviously why achieving margin is important. But you guys want to talk a little bit about how you use in clinical practice right now, how you use margin confirmation. And is it a linear, I'd like to know, is it a linear relationship between margin and recurrence? And obviously there would be at some point some diminishing returns from getting a bigger and bigger margin and obviously higher risk of complications. But I'd just like to hear in clinical practice sort of what you think best practices are. Obviously we're trying to establish a new standard of care with a claim, but I'd like to hear what you guys think right now.
Speaker 1
Okay, yes, we're using 3D confirmation, at least in my place for quite a few years right now. And does it correlate with local tumor control? Yes, and we have shown that in prospective and retrospective data and Bruno has done the same and others have done the same. And even more telling is the fact that local recurrence is concordant with the area with the margin is suboptimal. One of the things that is still unknown to most of us is a 5mm margin, suboptimal or is it a 10mm margin, suboptimal or is it 3mm margin, suboptimal. And the difficulty on answering that is because the size of the margin greatly depends on the input of the images you put in the machine. Obviously we are putting images at 5mm margins, a 5mm thickness, it cut anything under 5mm measurement is unreliable. Because the standard deviation is probably 5mm anyway, so it's like it's very hard to do anything else.

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