1 Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada.
2 PhD - Vanier Scholar, Canadian Institute for Health Research, Ottawa, Canada.
3 Royal College of Surgeons in Ireland, School of Medicine, 123 St. Stephen's Green, Dublin 2, Dublin, Ireland.
4 Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada.
5 Department of Computer Science and Software Engineering, Gina Cody School of Engineering and Computer Science, Concordia University, 1455 Boul. de Maisonneuve Ouest, Montreal, Quebec, H3G 1M8, Canada.
6 National Research Council, Institute of Biophysics, Moruzzi 1, I-56124 Pisa, Italy.

Osteosarcoma is the most common malignant tumour of the bone. Complete surgical excision is critical to achieve optimal outcomes and lower recurrence rates. However, accurate assessment of tumour margins remains a challenge and multiple technologies are employed for this purpose. The aim of this study is to highlight current and emerging technologies and their efficacy in detecting clear bone margins intraoperatively, through a systematic review of the literature. The following databases were searched using the OVID platform: Medline, Embase, Global Health and Google Scholar. Studies were screened using predetermined eligibility criteria. Data was extracted based on study and patient characteristics, modes of detection, and commercial availability, followed by quality assessment. A total of 17 studies were included. The primary diagnosis varied, with osteosarcoma being reported by 9 studies. Three studies reported relapse, ranging between 17.6%-48%. Twelve studies reported non-invasive imaging as the mode of detection used, while 4 studies reported the use of frozen section. MRI and CT were found to have an accuracy of up to 93 %. Raman spectroscopy was reported to have an accuracy, sensitivity, and specificity of 69%, 58.8% and 83.3% respectively. CT had a sensitivity and specificity up to 83% and 100%, respectively. In conclusion, there seems to be high potential for the use of multimodal technologies to increase the accuracy of intraoperative margin assessment. Although imaging modalities possess a fair level of accuracy, they carry the risk of radiation exposure, are expensive, and cannot be used in-situ. Future clinical trials are needed to test the effectiveness of these technologies to measure the diagnostic accuracy and overall patient survival.