PREOPERATIVE DELINEATION OF DEEPLY INVASIVE CUTANEOUS TUMORS: A SYSTEMATIC REVIEW OF HIGH-PRECISION IMAGING TECHNIQUES AND OUTCOMES

To achieve oncological control and functional preservation, deep invasion of cutaneous tumours should be properly detected during preoperative diagnosis. New imaging methods of high precision are emerging to enhance depth and margin evaluation in locations where clinical inspection and conventional imaging are insufficient. We aimed to evaluate diagnostic performance and impact on surgical planning, and evidence for oncologic and functional outcomes associated with advanced imaging technologies for preoperative assessment of deep cutaneous invasion. A systematic review was done cross several databases like MEDLINE, Embase, Cochrane and ClinicalTrials.gov. Eligible studies were proposals, prospective series, relevant observational studies and trial cohorts with diagnostic accuracy evaluation where high-precision imaging was compared with histopathology/surgery findings. QUADAS-2, ROBINS-I and ROBIS assessed the risk of bias. Twenty-two studies met inclusion. High-resolution MRI correlated the best to histology, and showed measurable reductions in re-excision rates, especially for facial and complex sites. High-frequency ultrasound was able to give accurate real-time estimates of depth but was operator-dependent and not standardised in terms of reporting. Both OCT and RCM are examples of optical methods that can provide cellular-level lateral mapping but suffer from shallow penetration. In their initial trials, photoacoustic and terahertz outperformed X-ray imaging, offering complementary functional contrast and promising thickness estimates. However, these observations have yet to be validated in clinical workflows, and further investigation is warranted in this area. The majority of evidence relates to technical accuracy rather than patient centred outcomes.Using imaging scans can help reduce the incompleteness of the excision procedure in select places. Routine adoption should be targeted and evidence driven. Future experiments involving imaging will include the recurrence of the disease, nerve preservation and cost-effectiveness and standardized performance metrics.