1
|
Hubbard TJE, Shams O, Gardner B, Gibson F, Rowlands S, Harries T, Stone N. A systematic scoping review exploring variation in practice in specimen mammography for Intraoperative Margin Analysis in Breast Conserving Surgery and the role of artificial intelligence in optimising diagnostic accuracy. Eur J Radiol 2024; 181:111777. [PMID: 39393216 DOI: 10.1016/j.ejrad.2024.111777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/28/2024] [Accepted: 10/05/2024] [Indexed: 10/13/2024]
Abstract
PURPOSE Specimen Mammography (SM) is commonly used in Breast Conserving Surgery (BCS) for intraoperative margin analysis. A systematic scoping review was conducted to identify sources of methodological variation in Specimen Mammography Interpretation (SMI) and assess the role of Artificial Intelligence (AI) techniques to optimise Diagnostic Accuracy (DA). METHODS Embase, Pubmed, Cochrane and web of science databases were searched. Studies were included if SM was used for margin analysis for BCS with reported DA compared with pathological margin status and data extracted. RESULTS 1242 unique studies were identified, of which 40 were included. 39/40 studies did not utilise AI for SMI, with 4 studies comparing 2 relevant techniques, giving 43 non-AI study arms for analysis. There was wide variation in SM techniques, including number of views and location of SM. Specialist performing SMI in usual clinical practice was surgeon (13/39 studies;33 %), radiologist(s) (16/39;41 %), surgeon and radiologist (3/39;8 %) or not stated (7/39;18 %) which differed from the study specialist in 15/39 (38 %) of studies. Diagnostic accuracy in studies ranged from sensitivity 19-91.7 % and specificity 25-100 %. CONCLUSIONS There is marked variation in current techniques used for SM for intraoperative margin analysis with correspondingly disparate DA. Only 1 study applied AI to SMI, and we identify how AI could optimise SMI and a template for future work to apply AI techniques to SMI, reduce unwarranted variation and optimise DA.
Collapse
Affiliation(s)
- Thomas J E Hubbard
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Royal Devon University Healthcare NHS Trust, Exeter, UK.
| | - Ola Shams
- Royal Devon University Healthcare NHS Trust, Exeter, UK
| | - Benjamin Gardner
- Department of Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
| | - Finley Gibson
- Institute for Data Science and Artificial Intelligence, University of Exeter, Exeter, UK
| | - Sareh Rowlands
- Department of Computer Science, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
| | - Tim Harries
- Department of Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
| | - Nick Stone
- Department of Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
| |
Collapse
|
2
|
Dowling GP, Hehir CM, Daly GR, Hembrecht S, Keelan S, Giblin K, Alrawashdeh MM, Boland F, Hill ADK. Diagnostic accuracy of intraoperative methods for margin assessment in breast cancer surgery: A systematic review & meta-analysis. Breast 2024; 76:103749. [PMID: 38759577 PMCID: PMC11127275 DOI: 10.1016/j.breast.2024.103749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE There are a wide variety of intraoperative techniques available in breast surgery to achieve low rates for positive margins of excision. The objective of this systematic review was to determine the pooled diagnostic accuracy of intraoperative breast margin assessment techniques that have been evaluated in clinical practice. METHODS This study was performed in accordance with PRISMA guidelines. A systematic search of the literature was conducted to identify studies assessing the diagnostic accuracy of intraoperative margin assessment techniques. Only clinical studies with raw diagnostic accuracy data as compared with final permanent section histopathology were included in the meta-analysis. A bivariate model for diagnostic meta-analysis was used to determine overall pooled sensitivity and specificity. RESULTS Sixty-one studies were eligible for inclusion in this systematic review and meta-analysis. Cytology demonstrated the best diagnostic accuracy, with pooled sensitivity of 0.92 (95 % CI 0.77-0.98) and a pooled specificity of 0.95 (95 % CI 0.90-0.97). The findings also indicate good diagnostic accuracy for optical spectroscopy, with a pooled sensitivity of 0.86 (95 % CI 0.76-0.93) and a pooled specificity of 0.92 (95 % CI 0.82-0.97). CONCLUSION Pooled data indicate that optical spectroscopy, cytology and frozen section have the greatest diagnostic accuracy of currently available intraoperative margin assessment techniques. However, long turnaround time for results and their resource intensive nature has prevented widespread adoption of these methods. The aim of emerging technologies is to compete with the diagnostic accuracy of these established techniques, while improving speed and usability.
Collapse
Affiliation(s)
- Gavin P Dowling
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland.
| | - Cian M Hehir
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Gordon R Daly
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Sandra Hembrecht
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Stephen Keelan
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Katie Giblin
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Maen M Alrawashdeh
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Arnold D K Hill
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
3
|
Pfob A, Dubsky P. The underused potential of breast conserving therapy after neoadjuvant system treatment - Causes and solutions. Breast 2023; 67:110-115. [PMID: 36669994 PMCID: PMC9982288 DOI: 10.1016/j.breast.2023.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Breast conserving therapy (BCT), consisting of breast conserving surgery and subsequent radiotherapy, is an equivalent option to mastectomy for women with early breast cancer. Although BCT after neoadjuvant systemic treatment (NAST) has been routinely recommend by international guidelines since many years, the rate of BCT worldwide varies largely and its potential is still underused. While the rate of BCT in western countries has increased over the past decades to currently about 70%, the rate of BCT is as low as 10% in other countries. In this review, we will evaluate the underused potential of breast conservation after NAST, identify causes, and discuss possible solutions. We identified clinical and non-clinical causes for the underuse of BCT after NAST including uncertainties within the community regarding oncologic outcomes, the correct tumor localization after NAST, the management of multifocal and multicentric tumors, margin assessment, disparities of socio-economic aspects on a patient and national level, and psychological biases affecting the shared decision-making process between patients and clinicians. Possible solutions to mitigate the underuse of BCT after NAST include interdisciplinary teams that keep the whole patient pathway in mind, optimized treatment counseling and shared decision-making, and targeted financial support to alleviate disparities.
Collapse
Affiliation(s)
- André Pfob
- Department of Obstetrics & Gynecology, Heidelberg University Hospital, Germany; National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Peter Dubsky
- Breast Centre, Hirslanden Klinik St. Anna, Luzern, Switzerland,Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Austria
| |
Collapse
|
4
|
Fusco N, Rizzo A, Costarelli L, Santinelli A, Cerbelli B, Scatena C, Macrì E, Pietribiasi F, d’Amati G, Sapino A, Castellano I. Pathological examination of breast cancer samples before and after neoadjuvant therapy: recommendations from the Italian Group for the Study of Breast Pathology - Italian Society of Pathology (GIPaM-SIAPeC). Pathologica 2022; 114:104-110. [PMID: 35414722 PMCID: PMC9248246 DOI: 10.32074/1591-951x-747] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022] Open
Abstract
Neoadjuvant therapy (NAT) in breast cancer is administered to downstage the tumor, de-escalate surgery, and provide prognostic information that can be used to tailor subsequent adjuvant therapy. In this respect, the pathological evaluation of both pre-NAT biopsies and post-NAT surgical specimens is crucial to precisely assess the treatment response. With the increasing possibilities of NAT protocols and the rising number of eligible patients, it has become extremely important to standardize the pathological response assessment. Here, we provide an update on the recommendations of the Italian Group for the Study of Breast Pathology - the Italian Society of Pathology (GIPaM-SIAPeC) for the analysis of breast cancer samples before and after NAT.
Collapse
|