Skin fiducial markers enable accurate computerized navigation resection of simulated soft tissue tumors: A static cadaveric model pilot study.
BACKGROUND
This static cadaveric model pilot study evaluated the agreement between planned and resected margins of simulated soft tissue tumors (SSTT) using skin fiducial markers for computerized navigation registration.


METHODS
Markers were applied before magnetic resonance imaging scans of lower extremities implanted with SSTT. A navigation pointer was used for registration and to guide SSTT resection with approximately 10 mm planned margins. Digital calipers were used to measure resection margins. Kolmogorov-Smirnov tests were used to confirm measurement normality. A one-sample t test was used to determine measurement group differences (P ≤ 0.05). Bland-Altman analysis and histogram plots compared planned and resected margins.


RESULTS
Ninety-eight resection margins were measured. The planned margin mean was 10.0 mm (95% confidence interval [CI] = 9.8-10.2 mm) and the resected margin mean was 11.5 mm (95% CI = 11.0-12.1 mm). One-sample t test results identified a 0.75 mm, 95% CI = 0.5-0.99 mm difference (P < 0.001). Good measurement agreement was observed with 94.9% (93/98) of resections occurring within two standard deviations of the mean measurement difference.


CONCLUSIONS
Skin fiducial marker use for computerized navigation system registration displayed promising results. With further research, these markers may become an effective, noninvasive method for aiding in soft tissue tumor resection.
['Eccles|Christian|C|', 'Whitaker|John|J|', 'Nyland|John|J|http://orcid.org/0000-0001-9033-5020', 'Roberts|Craig|C|', 'Carlson|Jon|J|', 'Zamora|Rodolfo|R|http://orcid.org/0000-0003-0174-2869']
D000328:Adult D002102:Cadaver D003198:Computer Simulation D005260:Female D057918:Fiducial Markers D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D000072662:Margins of Excision D008954:Models, Biological D010865:Pilot Projects D011379:Prognosis D012867:Skin D012983:Soft Tissue Neoplasms D025321:Surgery, Computer-Assisted
magnetic resonance imaging (MRI) sarcoma surgical planning