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Program Number: B191
Session Name: Poster Session

Bone Dust Generated During Oncologic Surgery Contains Viable Tumor Cells

Kelly M Bridgham, MD¹; Emma De Ravin, MD¹; Hannah Kenny, MD¹; Annie Moroco, MD¹; Stacy Gargano, MD¹; Andrew South, PhD²; Adam Luginbuhl, MD¹; ¹Thomas Jefferson University Hospital; ²Sidney Kimmel Cancer Center

Introduction: Surgical management of skull-base malignancy regardless of open or endoscopic approaches at times have tumor invading the cranial base that require direct drilling.  We hypothesize that bone dust generated during this process has potential to contain viable tumor cells that may seed the surrounding surgical field.   

Methods: To assess bone dust for viable tumor cells, our model involved patients with SCC of the mandible with grossly involved bone. En-bloc tumor resection was undertaken, and specimens were taken to pathology for accession. Areas with both grossly involved bone and bone without evidence of disease were drilled using a standard cutting burr. A secondary aim was to compare the amount of bone dust produced using two techniques-- a standard cutting burr versus ultrasonic bone aspirator. Bone dust was isolated from the irrigant mixture for each method and underwent histologic analysis using standard H&E staining to assess for the presence of tumor cells. Additionally, dust/irrigant mixture was collected and underwent cell count and viability analysis using a Cellometer automated cell counter.  

Results: On microscopic H&E analysis, bone dust generated from drilling of grossly uninvolved bone contained viable marrow components (Figure 1A). Bone dust produced from drilling of bone with gross tumor invasion demonstrated viable squamous cell carcinoma in addition to bony matrix and osteoclasts (Figure 1B). Bone dust generated via both standard drill and ultrasonic bone aspirator techniques contained viable tumor cells on H&E histologic analysis (Figure 2). After adjustment for volume of bone drilled, the standard drill technique produced a higher cell count and viability as compared to the ultrasonic bone aspirator (8.14 cells/μl, 89% viability versus 3.04 cells/μl, 86% viability).   

Conclusions: Bone dust generated from drilling of bone with gross tumor invasion contains viable tumor cells. This has important implications for skull base tumors in which en-bloc resection is not possible. Dust generated from drilling of involved bone at the skull base may seed the surrounding surgical field. Studies are ongoing looking at barrier techniques to prevent dust dispersion and possible tumor seeding. 

Figure 1

 

 

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