Riley S Gilbertson, Sakshi Krishna, Joaquin Austerlitz, Andreja Radevic, Michael J Colello, Alexander N Perez, Reena Singh, Jennifer L Halpern, Herbert S Schwartz, Michael C Topf, Joshua M Lawrenz, Daniel J Johnson
All 36 specimens were scanned and mapped (21 soft tissue, 13 bone, 2 metastatic; median greatest specimen dimension 12.7 cm). Positive margins occurred in 13.9% (N = 5) of cases. VPRs were presented in multidisciplinary tumor boards in three of these five cases. AR guidance was implemented in eight staged-resection cases (N = 4 for positive margin re-resection, N = 4 for pre-reconstruction planning), 3D heat maps were created for eight cases, and intraoperative wound bed scanning was piloted once.
BACKGROUND: Text-based pathology reports inadequately communicate complex three-dimensional (3D) relationships in musculoskeletal oncology, potentially contributing to errors in re-resection and adjuvant treatment planning. While our prior 7-case pilot study established technical feasibility, the scalability of this workflow and its utility as a platform for further innovation have not been demonstrated.
METHODS: We conducted a prospective implementation study of 36 musculoskeletal oncology specimens at a tertiary sarcoma center between April 2023 and November 2025. Specimens underwent ex vivo 3D scanning using a structured light scanner, followed by virtual annotation using computer-aided design software to mirror the standard-of-care grossing process and create visual pathology reports (VPRs). The primary outcome was systematic implementation without disrupting standard processing. Secondary outcomes included platform-derived applications: augmented reality (AR)-guided re-resection, 3D margin heat maps, and 3D wound-bed scans.
RESULTS: All 36 specimens were scanned and mapped (21 soft tissue, 13 bone, 2 metastatic; median greatest specimen dimension 12.7 cm). Positive margins occurred in 13.9% (N = 5) of cases. VPRs were presented in multidisciplinary tumor boards in three of these five cases. AR guidance was implemented in eight staged-resection cases (N = 4 for positive margin re-resection, N = 4 for pre-reconstruction planning), 3D heat maps were created for eight cases, and intraoperative wound bed scanning was piloted once.
DISCUSSION/CONCLUSION: 3D specimen scanning and virtual mapping are scalable workflows providing a permanent visual record of resected specimens and functioning as a foundational platform for novel interventions. AR-guided surgery and 3D heat mapping demonstrate potential paradigm shifts from static reporting to dynamic, visual pathologic reporting and surgical guidance.