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Nguyen DL, Lotfalla M, Cimino-Mathews A, Habibi M, Ambinder EB. Radiologic-Pathologic Correlation of Nonmass Enhancement Contiguous with Malignant Index Breast Cancer Masses at Preoperative Breast MRI. Radiol Imaging Cancer 2024; 6:e230060. [PMID: 38305717 PMCID: PMC10988334 DOI: 10.1148/rycan.230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/04/2023] [Accepted: 12/15/2023] [Indexed: 02/03/2024]
Abstract
Purpose To determine the pathologic features of nonmass enhancement (NME) directly adjacent to biopsy-proven malignant masses (index masses) at preoperative MRI and determine imaging characteristics that are associated with a malignant pathologic condition. Materials and Methods This retrospective study involved the review of breast MRI and mammography examinations performed for evaluating disease extent in patients newly diagnosed with breast cancer from July 1, 2016, to September 30, 2019. Inclusion criteria were limited to patients with an index mass and the presence of NME extending directly from the mass margins. Wilcoxon rank sum test, Fisher exact test, and χ2 test were used to analyze cancer, patient, and imaging characteristics associated with the NME diagnosis. Results Fifty-eight patients (mean age, 58 years ± 12 [SD]; all women) were included. Malignant pathologic findings for mass-associated NME occurred in 64% (37 of 58) of patients, 43% (16 of 37) with ductal carcinoma in situ and 57% (21 of 37) with invasive carcinoma. NME was more likely to be malignant when associated with an index cancer that had a low Ki-67 index (<20%) (P = .04). The presence of calcifications at mammography correlating with mass-associated NME was not significantly associated with malignant pathologic conditions (P = .19). The span of suspicious enhancement measured at MRI overestimated the true span of disease at histologic evaluation (P < .001), while there was no evidence of a difference between span of calcifications at mammography and true span of disease at histologic evaluation (P = .27). Conclusion Mass-associated NME at preoperative MRI was malignant in most patients with newly diagnosed breast cancer. The span of suspicious enhancement measured at MRI overestimated the true span of disease found at histologic evaluation. Keywords: Breast, Mammography © RSNA, 2024 See also the commentary by Newell in this issue.
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Affiliation(s)
| | | | - Ashley Cimino-Mathews
- From the Department of Radiology, Duke University Medical Center,
Durham, NC (D.L.N.); Department of Pathology, University of South Florida Health
Morsani College of Medicine, Tampa, Fla (M.L.); and Department of Pathology
(A.C.M.), Department of Surgery (M.H.), and Russell H. Morgan Department of
Radiology and Radiological Science (E.B.A.), Johns Hopkins Medicine, 601 N
Caroline St, Baltimore, MD 21287
| | - Mehran Habibi
- From the Department of Radiology, Duke University Medical Center,
Durham, NC (D.L.N.); Department of Pathology, University of South Florida Health
Morsani College of Medicine, Tampa, Fla (M.L.); and Department of Pathology
(A.C.M.), Department of Surgery (M.H.), and Russell H. Morgan Department of
Radiology and Radiological Science (E.B.A.), Johns Hopkins Medicine, 601 N
Caroline St, Baltimore, MD 21287
| | - Emily B. Ambinder
- From the Department of Radiology, Duke University Medical Center,
Durham, NC (D.L.N.); Department of Pathology, University of South Florida Health
Morsani College of Medicine, Tampa, Fla (M.L.); and Department of Pathology
(A.C.M.), Department of Surgery (M.H.), and Russell H. Morgan Department of
Radiology and Radiological Science (E.B.A.), Johns Hopkins Medicine, 601 N
Caroline St, Baltimore, MD 21287
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Porte C, Lisson T, Kohlen M, von Maltzahn F, Dencks S, von Stillfried S, Piepenbrock M, Rix A, Dasgupta A, Koczera P, Boor P, Stickeler E, Schmitz G, Kiessling F. Ultrasound Localization Microscopy for Breast Cancer Imaging in Patients: Protocol Optimization and Comparison with Shear Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:57-66. [PMID: 37805359 DOI: 10.1016/j.ultrasmedbio.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/25/2023] [Accepted: 09/02/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Ultrasound localization microscopy (ULM) has gained increasing attention in recent years because of its ability to visualize blood vessels at super-resolution. The field of oncology, in particular, could benefit from detailed vascular characterization, for example, for diagnosis and therapy monitoring. This study was aimed at refining ULM for breast cancer patients by optimizing the measurement protocol, identifying translational challenges and combining ULM and shear wave elastography. METHODS We computed ULM images of 11 patients with breast cancer by recording contrast-enhanced ultrasound (CEUS) sequences and post-processing them in an offline pipeline. For CEUS, two different doses and injection speeds of SonoVue were applied. The best injection protocol was determined based on quantitative parameters derived from so-called occurrence maps. In addition, a suitable measurement time window was determined, also considering the occurrence of motion. ULM results were compared with shear wave elastography and histological vessel density. RESULTS At the higher dose and injection speed, the highest number of microbubbles, number of tracks and vessel coverage were achieved, leading to the most detailed representation of tumor vasculature. Even at the highest concentration, no significant overlay of microbubble signals occurred. Motion significantly reduced the number of usable frames, thus limiting the measurement window to 3.5 min. ULM vessel coverage was comparable to the histological vessel fraction and correlated significantly with mean tumor elasticity. CONCLUSION The settings for microbubble injection strongly influence ULM images, thus requiring optimized protocols for different indications. Patient and examiner motion was identified as the main translational challenge for ULM.
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Affiliation(s)
- Céline Porte
- Institute for Experimental Molecular Imaging, University Clinic Aachen, RWTH Aachen University, Aachen, Germany
| | - Thomas Lisson
- Department of Electrical Engineering and Information Technology, Ruhr University Bochum, Bochum, Germany
| | - Matthias Kohlen
- Department of Gynecology and Obstetrics, University Clinic Aachen, RWTH Aachen University, Aachen, Germany
| | - Finn von Maltzahn
- Institute for Experimental Molecular Imaging, University Clinic Aachen, RWTH Aachen University, Aachen, Germany
| | - Stefanie Dencks
- Department of Electrical Engineering and Information Technology, Ruhr University Bochum, Bochum, Germany
| | - Saskia von Stillfried
- Institute of Pathology, University Clinic Aachen, RWTH Aachen University, Aachen, Germany
| | - Marion Piepenbrock
- Department of Electrical Engineering and Information Technology, Ruhr University Bochum, Bochum, Germany
| | - Anne Rix
- Institute for Experimental Molecular Imaging, University Clinic Aachen, RWTH Aachen University, Aachen, Germany
| | - Anshuman Dasgupta
- Institute for Experimental Molecular Imaging, University Clinic Aachen, RWTH Aachen University, Aachen, Germany
| | - Patrick Koczera
- Institute for Experimental Molecular Imaging, University Clinic Aachen, RWTH Aachen University, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, University Clinic Aachen, RWTH Aachen University, Aachen, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, University Clinic Aachen, RWTH Aachen University, Aachen, Germany
| | - Georg Schmitz
- Department of Electrical Engineering and Information Technology, Ruhr University Bochum, Bochum, Germany
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, University Clinic Aachen, RWTH Aachen University, Aachen, Germany; Fraunhofer Institute for Digital Medicine MEVIS, Aachen, Germany.
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Jeong D, Morse B, Polk SL, Chen DT, Li J, Hodul P, Centeno BA, Costello J, Jiang K, Machado S, El Naqa I, Farah PT, Huynh T, Raghunand N, Mok S, Dam A, Malafa M, Qayyum A, Fleming JB, Permuth JB. Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology. Cancers (Basel) 2024; 16:206. [PMID: 38201633 PMCID: PMC10778543 DOI: 10.3390/cancers16010206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND While multiple cyst features are evaluated for stratifying pancreatic intraductal papillary mucinous neoplasms (IPMN), cyst size is an important factor that can influence treatment strategies. When magnetic resonance imaging (MRI) is used to evaluate IPMNs, no universally accepted sequence provides optimal size measurements. T2-weighted coronal/axial have been suggested as primary measurement sequences; however, it remains unknown how well these and maximum all-sequence diameter measurements correlate with pathology size. This study aims to compare agreement and bias between IPMN long-axis measurements on seven commonly obtained MRI sequences with pathologic size measurements. METHODS This retrospective cohort included surgically resected IPMN cases with preoperative MRI exams. Long-axis diameter tumor measurements and the presence of worrisome features and/orhigh-risk stigmata were noted on all seven MRI sequences. MRI size and pathology agreement and MRI inter-observer agreement involved concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC), respectively. The presence of worrisome features and high-risk stigmata were compared to the tumor grade using kappa analysis. The Bland-Altman analysis assessed the systematic bias between MRI-size and pathology. RESULTS In 52 patients (age 68 ± 13 years, 22 males), MRI sequences produced mean long-axis tumor measurements from 2.45-2.65 cm. The maximum MRI lesion size had a strong agreement with pathology (CCC = 0.82 (95% CI: 0.71-0.89)). The maximum IPMN size was typically observed on the axial T1 arterial post-contrast and MRCP coronal series and overestimated size versus pathology with bias +0.34 cm. The radiologist interobserver agreement reached ICCs 0.74 to 0.91 on the MRI sequences. CONCLUSION The maximum MRI IPMN size strongly correlated with but tended to overestimate the length compared to the pathology, potentially related to formalin tissue shrinkage during tissue processing.
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Affiliation(s)
- Daniel Jeong
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.M.); (J.C.); (A.Q.)
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 3011 Holly Drive, Tampa, FL 33612, USA;
| | - Brian Morse
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.M.); (J.C.); (A.Q.)
| | - Stuart Lane Polk
- College of Medicine, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Dung-Tsa Chen
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (D.-T.C.); (J.L.)
| | - Jiannong Li
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (D.-T.C.); (J.L.)
| | - Pamela Hodul
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Barbara A. Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.A.C.); (K.J.)
| | - James Costello
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.M.); (J.C.); (A.Q.)
| | - Kun Jiang
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.A.C.); (K.J.)
| | - Sebastian Machado
- Department of Clinical Science, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (S.M.); (P.T.F.)
| | - Issam El Naqa
- Department of Machine Learning, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Paola T. Farah
- Department of Clinical Science, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (S.M.); (P.T.F.)
| | - Tri Huynh
- College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA;
| | - Natarajan Raghunand
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Shaffer Mok
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Aamir Dam
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Mokenge Malafa
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Aliya Qayyum
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.M.); (J.C.); (A.Q.)
| | - Jason B. Fleming
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Jennifer B. Permuth
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 3011 Holly Drive, Tampa, FL 33612, USA;
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
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K K, Kamboj V, Sreedharan S, Shenoy S V, Rai T, Kabekkodu S. Effect of formalin fixation on tumour size and margins in head and neck cancer specimens. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:434-440. [PMID: 36541381 PMCID: PMC9793140 DOI: 10.14639/0392-100x-n2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/25/2022] [Indexed: 12/24/2022]
Abstract
Objectives To quantify tumour size and margin shrinkage due to formalin fixation in head and neck cancer specimens and determine its effect on tumour staging and margin clearance. Methods Tumour specimens were measured immediate post-resection and at 24 hours after fixation. Tumour was measured in 2 dimensions and one margin was measured. Shrinkage was categorised as < 10%, 10-20%, and > 20%. Effect of shrinkage on tumour stage and margin clearance were evaluated. Results A total of 50 specimens were analysed. The tumour AP (Anterior Posterior) and SI (Superior Inferior) measurements showed significant shrinkage with a mean difference of 22.93% and 21.69% respectively. > 20% shrinkage was noted in 78% of AP and 58% of SI measurements. Margins showed a mean difference of 25.61%. 84% of margins demonstrated > 20% shrinkage. In all, 46.7% of T3 and 23% of T2 tumours pre-fixation were downstaged to T2 and T1, respectively, post-fixation. Conclusions Formalin fixation alone can be responsible for significant shrinkage of tumour and margin dimensions in head and neck specimens. It is suggested that decisions regarding the treatment plan should be made on clinical staging of primary tumour rather than pathological staging. In addition, post-excision pre-fixation margins should be considered for treatment planning.
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Affiliation(s)
| | | | - Suja Sreedharan
- Correspondence Suja Sreedharan Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India PIN 575001 E-mail:
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Quantification of Canine Apocrine Gland Anal Sac Adenocarcinoma (AGASACA) Tumor Specimen Shrinkage after Formalin Fixation. Animals (Basel) 2022; 12:ani12151869. [PMID: 35892519 PMCID: PMC9330584 DOI: 10.3390/ani12151869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary As the evidence in apocrine gland anal sac adenocarcinoma tumors grows, it is becoming more evident that stage-specific treatment strategies will become the mainstay. Thus, having confidence in the measurements of primary tumors is paramount. We aimed to quantify the degree of tumor tissue shrinkage after 24 and 48 h of formalin fixation to guide clinicians in their use of post-fixation measurements. We prospectively enrolled 23 client-owned dogs with naturally occurring apocrine gland anal sac adenocarcinoma that underwent surgical resection of at least the primary tumor. Measurements were recorded immediately before being placed in 10% buffered formalin and then again after 24 and 48 h of fixation, respectively. Overall, we found that tumors shrank by a mean of 4.8% and 7.2% after 24 and 48 h, respectively. This in real terms was a median of 1 mm. Other factors associated with the tumor, like the predominant microscopic pattern, the amount of necrosis, or the amount of fibrovascular stroma, did not have an impact on the degree of shrinkage. This study shows that the degree of shrinkage following formalin fixation should not impact the use of post-fixation measurements and can be used in clinical staging schema. Abstract The aim was to prospectively measure the shrinkage of primary apocrine gland anal sac adenocarcinoma (AGASACA) tumors after 24 and 48 h of formalin fixation. Dogs that were diagnosed with AGASACA pre-operatively by aspiration cytology were prospectively enrolled in the study. Tumor extirpation was performed in a closed technique. The tumor and associated tissues were examined on the back table away from the patient and the widest dimension of the tumor was measured using a sterile ruler (Medline®; Northfield, IL, USA). This measurement was recorded in mm (t0). The tissue was placed in 10% buffered formalin and stored at room temperature. Two further measurements were taken after 24 (t24) and 48 (t48) hours of formalin fixation. Once the 48 h measurement was taken, the tissue was submitted for histopathology. The percentage of shrinkage between time points was calculated by using the following equation: (1 − [time b/time a]) × 100. Overall, 23 dogs with 23 tumors were enrolled. The mean percentage of shrinkage after 24 and 48 h of formalin fixation was 4.8% and 7.2%, respectively. The median diameter of the tumors reduced by 1 mm over 48 h and was not significantly different at any time point. These data will aid clinicians in interpreting measurements of AGASACA tumors following formalin fixation and shows that minimal change in tumor size is expected following 48 h.
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Kiruparan N, Kiruparan P, Debnath D. Use of wire guided localisation and radio-guided occult lesion localisation for non-palpable breast lesions: A systematic literature review and meta-analysis of current evidence. Asian J Surg 2021; 45:79-88. [PMID: 34479779 DOI: 10.1016/j.asjsur.2021.06.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer screening has seen an increase in the detection of non-palpable breast lesions. Wire guided localisation (WGL) and Radio-guided occult lesion localisation (ROLL) are well established modalities of localisation of non-palpable breast lesions in the UK. We aimed to compare the outcomes of WGL and ROLL in this updated meta-analysis. We searched Cochrane Central Register of Controlled Trials (CENTRAL), and LILACS using free text search words as well as relevant MESH-terms. We also searched Medline (02/03/2021), Embase and registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Outcomes considered were re-excision rates, margin involvement, specimen volume and weight, accurate localisation of lesions and operative time. We assessed the risk of bias in included studies and performed random effects meta-analyses using Review Manager (version 5.3). Heterogeneity was estimated using the I2-statistic. Nine included studies enrolled 1096 patients undergoing localization in breast surgery (534 in WGL and 562 in ROLL). There was a statistically significant benefit in favour of ROLL for non-involved resection margins (OR 0.60; 95% CI, 0.44-0.97); based on seven studies. Nine trials assessed operative time favouring ROLL (OR 1.95; 95% CI, 0.27-3.63). No significant difference in re-excision rates was reported (OR 1.42; 95% CI, 0.83-2.43) based on seven studies. Current evidence favourably supports ROLL, compared to WGL, with respect to margin involvement, localisation and operative time in the treatment of non-palpable breast lesions.
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Adeniran BV, Bjarkadottir BD, Appeltant R, Lane S, Williams SA. Improved preservation of ovarian tissue morphology that is compatible with antigen detection using a fixative mixture of formalin and acetic acid. Hum Reprod 2021; 36:1871-1890. [PMID: 33956944 PMCID: PMC8213453 DOI: 10.1093/humrep/deab075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/13/2021] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Can ovarian tissue morphology be better preserved whilst enabling histological molecular analyses following fixation with a novel fixative, neutral buffered formalin (NBF) with 5% acetic acid (referred to hereafter as Form-Acetic)? SUMMARY ANSWER Fixation with Form-Acetic improved ovarian tissue histology compared to NBF in multiple species while still enabling histological molecular analyses. WHAT IS KNOWN ALREADY NBF fixation results in tissue shrinkage in various tissue types including the ovary. Components of ovarian tissue, notably follicles, are particularly susceptible to NBF-induced morphological alterations and can lead to data misrepresentation. Bouin’s solution (which contains 5% acetic acid) better preserves tissue architecture compared to NBF but is limited for immunohistochemical analyses. STUDY DESIGN, SIZE, DURATION A comparison of routinely used fixatives, NBF and Bouin’s, and a new fixative, Form-Acetic was carried out. Ovarian tissue was used from three different species: human (n = 5 patients), sheep (n = 3; 6 ovaries; 3 animals per condition) and mouse (n = 14 mice; 3 ovaries from 3 different animals per condition). PARTICIPANTS/MATERIALS, SETTING, METHODS Ovarian tissue from humans (aged 13 weeks to 32 years), sheep (reproductively young i.e. 3–6 months) and mice (10 weeks old) were obtained and fixed in 2 ml NBF, Bouin’s or Form-Acetic for 4, 8, and 24 h at room temperature. Tissues were embedded and sectioned. Five-micron sections were stained with haemotoxylin and eosin (H&E) and the percentage of artefact (clear space as a result of shrinkage) between ovarian structures was calculated. Additional histological staining using Periodic acid-Schiff and Masson’s trichrome were performed on 8 and 24 h NBF, Bouin’s and Form-Acetic fixed samples to assess the compatibility of the new fixative with stains. On ovarian tissue fixed for both 8 and 24 h in NBF and Form-Acetic, immunohistochemistry (IHC) studies to detect FOXO3a, FoxL2, collagen IV, laminin and anti-Müllerian hormone (AMH) proteins were performed in addition to the terminal deoxynucleotidyl transferase nick end labelling (TUNEL) assay to determine the compatibility of Form-Acetic fixation with types of histological molecular analyses. MAIN RESULTS AND THE ROLE OF CHANCE Fixation in Form-Acetic improved ovarian tissue morphology compared to NBF from all three species and either slightly improved or was comparable to Bouin’s for human, mouse and sheep tissues. Form-Acetic was compatible with H&E, Periodic acid-Schiff and Masson’s trichrome staining and all proteins (FOXO3a, FoxL2, collagen IV and laminin and AMH) could be detected via IHC. Furthermore, Form-Acetic, unlike NBF, enabled antigen recognition for most of the proteins tested without the need for antigen retrieval. Form-Acetic also enabled the detection of damaged DNA via the TUNEL assay using fluorescence. LARGE SCALE DATA N/A LIMITATIONS, REASONS FOR CAUTION In this study, IHC analysis was performed on a select number of protein types in ovarian tissue thus encouraging further studies to confirm the use of Form-Acetic in enabling the detection of a wider range of protein forms in addition to other tissue types. WIDER IMPLICATIONS OF THE FINDINGS The simplicity in preparation of Form-Acetic and its superior preservative properties whilst enabling forms of histological molecular analyses make it a highly valuable tool for studying ovarian tissue. We, therefore, recommend that Form-Acetic replaces currently used fixatives and encourage others to introduce it into their research workflow. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Oxford Medical Research Council Doctoral Training Programme (Oxford MRC-DTP) grant awarded to B.D.B. (Grant no. MR/N013468/1), the Fondation Hoffmann supporting R.A. and the Petroleum Technology Development Fund (PTDF) awarded to B.V.A.
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Affiliation(s)
- B V Adeniran
- Nuffield Department of Women's and Reproductive Health, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - B D Bjarkadottir
- Nuffield Department of Women's and Reproductive Health, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - R Appeltant
- Nuffield Department of Women's and Reproductive Health, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - S Lane
- Future Fertility Programme Oxford, Oxford, UK.,Department of Paediatric Oncology and Haematology, Children's Hospital Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S A Williams
- Nuffield Department of Women's and Reproductive Health, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Future Fertility Programme Oxford, Oxford, UK
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İlhan E, Üreyen O, Tan S, Şimşek C, Erkul Z, Yakan S, Kızanoglu H, Uslu A, Yildirim M. Post Colectomy and Post Fixation Margin Measurement Correction Factor. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kato E, Mori N, Mugikura S, Sato S, Ishida T, Takase K. Value of ultrafast and standard dynamic contrast-enhanced magnetic resonance imaging in the evaluation of the presence and extension of residual disease after neoadjuvant chemotherapy in breast cancer. Jpn J Radiol 2021; 39:791-801. [PMID: 33743147 DOI: 10.1007/s11604-021-01110-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/13/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of ultrafast and standard dynamic contrast-enhanced (DCE)-MRI in evaluating the residual disease after neoadjuvant chemotherapy (NAC) for breast cancer. MATERIALS AND METHODS Sixty-seven consecutive patients underwent MRI after NAC. Visual analysis of enhancement was performed on ultrafast and standard DCE-MRI, and compared between no residual disease and residual disease groups. The lesion diameters measured on the last phase of ultrafast DCE-MRI and early and delayed phases of standard DCE-MRI were compared with pathological diameter of entire residual cancer and residual invasive ductal carcinoma (IDC). RESULTS The visual analysis in the delayed phase of standard DCE-MRI exhibited the highest sensitivity (90%), whereas ultrafast DCE-MRI revealed the highest positive predictive value (92%). There were no significant differences between the diameters in the delayed phase of the standard DCE-MRI and the pathological entire residual cancer (p = 0.97), and the diameters in ultrafast DCE-MRI and the pathological residual IDC (p = 0.97). CONCLUSION The delayed phase of standard DCE-MRI may be effective for detecting the residual disease and evaluating the extension of entire residual cancer. Enhancement in ultrafast DCE-MRI may be strongly suggestive of the presence of residual disease, and effective for evaluating the extension of residual IDC.
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Affiliation(s)
- Erina Kato
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.,Department of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Seiryo 2-1, Sendai, 980-8574, Japan
| | - Satoko Sato
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Takanori Ishida
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan
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10
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Haddad M, Xu B, Pun C, Lu FI, Parra-Herran C, Nofech-Mozes S, Slodkowska E. Breast Specimen Measurement Methodology and Its Potential Major Impact on Tumor Size. Int J Surg Pathol 2020; 29:39-45. [PMID: 33000664 DOI: 10.1177/1066896920962184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Pathologic tumor size assessment highly depends on the gross specimen size once microscopic cancer size exceeds its macroscopic size, in particular if the dimension along the plane of sectioning is the greatest. We hypothesize that the method by which the specimen size is estimated can yield significantly different tumor size measurements and thus affect breast cancer staging and treatment. METHODS The size in the plane of sectioning of 50 lumpectomies over 4 cm was examined by 5 methods: measured grossly in the fresh state and postfixation, and calculated from the gross measurements by 3 different methods. For 15 mastectomies, we measured and calculated the span of the middle 4 and 6 slices using 3 methods. RESULTS For all 50 lumpectomies, fresh measurement yielded the largest size. The difference in size of lumpectomies was greater with increasing specimen size (P < .001). Using the method of adding 0.4 cm per each submitted sequential section yielded the smallest size in most cases. In mastectomies the span of the middle 4 and 6 slices was significantly larger if calculated from the average slice thickness based on the specimen size. CONCLUSION The method of specimen size measurement has implications in estimation of tumor size and patient management. It is essential that pathologists be aware of the technique used and its limitations. For individual slice thickness, we highly recommend using the measurements obtained at the time of grossing rather than calculating the average slice thickness from the specimen size.
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Affiliation(s)
- Moreen Haddad
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Bin Xu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cherry Pun
- University of Toronto, Toronto, Ontario, Canada
| | - Fang-I Lu
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Carlos Parra-Herran
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Sharon Nofech-Mozes
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Elzbieta Slodkowska
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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11
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Sorrentino L, Agozzino M, Albasini S, Bossi D, Mazzucchelli S, Vanna R, Papadopoulou O, Villani L, Corsi F. Involved margins after lumpectomy for breast cancer: Always to be re-excised? Surg Oncol 2019; 30:141-146. [PMID: 31500779 DOI: 10.1016/j.suronc.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/14/2019] [Accepted: 08/05/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The oncologic benefit of upfront re-excision of involved margins after breast-conserving surgery in the context of current multimodal clinical management of breast cancer is unclear. The aim of the present study was to assess the 5-years locoregional recurrence (LRR)-free and distant metastases (DM)-free survival probabilities in patients not undergoing re-excision of positive margins after lumpectomy for breast cancer. METHODS A cohort of 104 patients with positive margins not undergoing re-excision was matched by propensity score with a cohort of 2006 control patients with clear margins after breast-conserving surgery, treated between 2008 and 2018. A multivariate survival analysis was performed accounting for all variables related to LRR and DM, including adjuvant treatments. RESULTS After adjusting for potential confounders, avoiding to re-excise a positive margin after lumpectomy had no effect on 5-years LRR-free survival probability (HR 0.98, 95%CI 0.36-2.67, p = 0.96) or 5-years DM-free survival probability (HR 0.37, 95%CI 0.08-1.61, p = 0.18). No correlation was found between occurrence of LRR and number of involved margins (HR 1.28, 95%CI 0.10-12.4, Log-rank p = 0.83), or extension of infiltrating disease (HR 1.21, 95%CI 0.20-7.40, Log-rank p = 0.83), but a trend toward higher LRR probability was found for invasive ductal (HR 6.92, 95%CI 0.7-68.8, Log-rank p = 0.10) and invasive lobular cancer (HR 12.95, 95%CI 0.79-213.6, Log-rank p = 0.07) on positive margins. CONCLUSIONS In the era of multimodal treatment of breast cancer and accurate strategies to reduce the probability of residual disease in the post-lumpectomy cavity, re-excision of positive margins might be omitted in selected patients with low-risk breast cancers.
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Affiliation(s)
- Luca Sorrentino
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
| | - Manuela Agozzino
- Pathology Unit, Istituti Clinici Scientifici Maugeri IRCCS, via S. Maugeri 10, 27100, Pavia, Italy
| | - Sara Albasini
- Surgery Department, Breast Unit, Istituti Clinici Scientifici Maugeri IRCCS, via S. Maugeri 10, 27100, Pavia, Italy
| | - Daniela Bossi
- Surgery Department, Breast Unit, Istituti Clinici Scientifici Maugeri IRCCS, via S. Maugeri 10, 27100, Pavia, Italy
| | - Serena Mazzucchelli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
| | - Renzo Vanna
- Nanomedicine and Molecular Imaging Lab, Istituti Clinici Scientifici Maugeri IRCCS, via S. Maugeri 10, Pavia, Italy
| | - Ourania Papadopoulou
- Service of Breast Radiology, Department of Radiology, Istituti Clinici Scientifici Maugeri IRCCS, via. S. Maugeri 10, Pavia, Italy
| | - Laura Villani
- Pathology Unit, Istituti Clinici Scientifici Maugeri IRCCS, via S. Maugeri 10, 27100, Pavia, Italy
| | - Fabio Corsi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, via G. B. Grassi 74, 20157, Milan, Italy.
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12
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Abstract
Resection margins in colorectal cancer carry clinical significance with regard to disease recurrence risk and selection for multimodal adjuvant therapy, especially with circumferential resection margins in rectal cancer. Colorectal cancer specimens are routinely fixed in formalin, which results in specimen and tumor-free margin shrinkage. However, the effects of shrinkage have not traditionally been taken into account when analyzing tumor-free margins. In this prospective study, 46 colorectal cancer specimens were measured in the fresh state and subsequently after formalin fixation for total specimen length, distal resection margin, and radial margin (circumferential resection margin for rectal cancer). The mean reduction after formalin fixation was 17.48 mm (14.7%) for distal resection margin and 1.20 mm (10.5%) for radial margin. For rectal cancer, circumferential resection margin reduction was 0.88 mm (11.8%); this was not affected by neoadjuvant chemoradiotherapy. Duration of formalin fixation did not significantly affect the extent of margin shrinkage. This is the first study to evaluate the effect of formalin fixation on radial resection margins, specifically as it relates to rectal cancer, and it demonstrates that shrinkage from formalin fixation should be a consideration in decision-making where the magnitude of tumor-free margins is small.
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13
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Upchurch DA, Klocke EE, Henningson JN. Amount of skin shrinkage affecting tumor versus grossly normal marginal skin of dogs for cutaneous mast cell tumors excised with curative intent. Am J Vet Res 2018; 79:779-786. [DOI: 10.2460/ajvr.79.7.779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Lacout A, Chamorey E, Thariat J, El Hajjam M, Chevenet C, Schiappa R, Marcy PY. Insight into Differentiated Thyroid Cancer Gross Pathological Specimen Shrinkage and Its Influence on TNM Staging. Eur Thyroid J 2017; 6:315-320. [PMID: 29234625 PMCID: PMC5704705 DOI: 10.1159/000478774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/17/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This study aimed at comparing thyroid cancer staging when taking into account the differences between the "T" assessment" using ultrasound (US) and histopathological measurements. MATERIAL AND METHODS This retrospective study included all consecutive differentiated follicular thyroid cancer (DTC) and medullary thyroid cancer (MTC) patients who underwent postoperative histopathological staging assessment at a single institution. Anaplastic thyroid carcinomas were excluded from the present study. Each malignant thyroid nodule was precisely evaluated by measuring its long axis using both US and gross specimen histopathological examination. T stage classification was attributed to each tumor as regards US (solely according to the tumor dimension) and histopathology: (1) solely according to the tumor dimension and (2) according to the tumor dimension and extrathyroidal extension features when present. RESULTS Retrospective comparison between US and histopathology size of the operated thyroid nodules showed a mean diminution of 7.52% of the tumor long axis. Tumors ≤10 mm at histopathological examination showed a larger decrease in size of 13% (p = 0.054, statistically significant) compared to the US measurements. Ten out of 72 (13.8%) patients showed final T downstaging in comparison to US assessment: (US) T2 to T1b in 6 patients (1 MTC) and (US) T1b to T1a in 4 patients (1 MTC). Two (2.9%) DTC patients were downstaged from stage 2 to stage 1. CONCLUSION Precise thyroid tumor US measurement may differ significantly from that obtained by histopathological assessment, which may result in a different TNM staging and subsequent patient management.
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Affiliation(s)
- Alexis Lacout
- Centre d'Imagerie Médicale, Aurillac, France
- *Dr. Alexis Lacout, Centre d'Imagerie Médicale, 47, Boulevard du Pont Rouge, FR-15000 Aurillac (France), E-Mail
| | - Emmanuel Chamorey
- Unité d'Epidémiologie et Biostatistiques (UEB), Centre Antoine Lacassagne, Nice, France
| | - Juliette Thariat
- Department of Radiation Oncology, Baclesse Cancer Research Institute, Caen, France
| | - Mostafa El Hajjam
- Department of Radiology, Centre Hospitalier Universitaire Ambroise Paré, APHP, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
| | - Carole Chevenet
- Laboratoire d'Anatomie et de Cytologie Pathologique du CHU Estaing, Clermont Ferrand, France
| | - Renaud Schiappa
- Unité d'Epidémiologie et de Biostatistiques (UEB), Département Recherche Clinique Innovation et Statistiques (DRIS), Centre Antoine Lacassagne, Nice, France
| | - Pierre Yves Marcy
- Polyclinique Les Fleurs, Service Imagerie Médicale, Ollioules, France
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15
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Nieminen H, Gahunia H, Pritzker K, Ylitalo T, Rieppo L, Karhula S, Lehenkari P, Hæggström E, Saarakkala S. 3D histopathological grading of osteochondral tissue using contrast-enhanced micro-computed tomography. Osteoarthritis Cartilage 2017; 25:1680-1689. [PMID: 28606558 PMCID: PMC5773475 DOI: 10.1016/j.joca.2017.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Histopathological grading of osteochondral (OC) tissue is widely used in osteoarthritis (OA) research, and it is relatively common in post-surgery in vitro diagnostics. However, relying on thin tissue section, this approach includes a number of limitations, such as: (1) destructiveness, (2) sample processing artefacts, (3) 2D section does not represent spatial 3D structure and composition of the tissue, and (4) the final outcome is subjective. To overcome these limitations, we recently developed a contrast-enhanced μCT (CEμCT) imaging technique to visualize the collagenous extracellular matrix (ECM) of articular cartilage (AC). In the present study, we demonstrate that histopathological scoring of OC tissue from CEμCT is feasible. Moreover, we establish a new, semi-quantitative OA μCT grading system for OC tissue. RESULTS Pathological features were clearly visualized in AC and subchondral bone (SB) with μCT and verified with histology, as demonstrated with image atlases. Comparison of histopathological grades (OARSI or severity (0-3)) across the characterization approaches, CEμCT and histology, excellent (0.92, 95% CI = [0.84, 0.96], n = 30) or fair (0.50, 95% CI = [0.16, 0.74], n = 27) intra-class correlations (ICC), respectively. A new μCT grading system was successfully established which achieved an excellent cross-method (μCT vs histology) reader-to-reader intra-class correlation (0.78, 95% CI = [0.58, 0.89], n = 27). CONCLUSIONS We demonstrated that histopathological information relevant to OA can reliably be obtained from CEμCT images. This new grading system could be used as a reference for 3D imaging and analysis techniques intended for volumetric evaluation of OA pathology in research and clinical applications.
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Affiliation(s)
- H.J. Nieminen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada,Department of Physics, University of Helsinki, Helsinki, Finland,Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland,Address correspondence and reprint requests to: H.J. Nieminen, Department of Neuroscience and Biomedical Engineering, Aalto University, School of Science, POB 12200, FI-00076 Aalto, Finland.Department of Neuroscience and Biomedical EngineeringAalto UniversitySchool of SciencePOB 12200AaltoFI-00076Finland
| | - H.K. Gahunia
- Orthopedic Science Consulting Services, Oakville, Ontario, Canada
| | - K.P.H. Pritzker
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada,Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, Canada
| | - T. Ylitalo
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland,Department of Physics, University of Helsinki, Helsinki, Finland
| | - L. Rieppo
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - S.S. Karhula
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland,Infotech Doctoral Program, University of Oulu, Oulu, Finland
| | - P. Lehenkari
- Department of Anatomy and Cell Biology, University of Oulu, Oulu, Finland,Department of Surgery and Intensive Care, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - E. Hæggström
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - S. Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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16
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Kansu L, Aydın E, Akkaya H, Avcı S, Akalın N. Shrinkage of Nasal Mucosa and Cartilage During Formalin Fixation. Balkan Med J 2017; 34:458-463. [PMID: 28552840 PMCID: PMC5635634 DOI: 10.4274/balkanmedj.2015.1470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND After resection, specimens are subjected to formalin fixation during histological processing. This procedure can result in tissue shrinkage, with the amount of shrinkage related to tissue composition and tissue type. AIMS To evaluate the shrinkage of nasal mucosa and cartilage tissue and compare differences in shrinkage after resection, after formalin fixation, and during microscopic examination to understand differences in the rate of shrinkage of different tissue types. STUDY DESIGN Animal experimentation. METHODS Fresh nasal septa were excised from sheep (10 mm diameter in 40 sheep and 20 mm diameter in 40 sheep). The mucosa was separated from one side of the cartilage, with the contralateral mucosa remaining attached to the cartilage. Specimen diameters were measured in situ, after resection, after fixation for 6 or 24 hours (10% formalin), and during microscopic examination. RESULTS There were no differences between the in situ and after resection diameters of any tissue components (free mucosa, mucosa attached to cartilage, and cartilage) of all nasal specimens (10- or 20-mm diameter and 6- or 24-hour fixation). However, significant shrinkage occurred between resection and after-fixation. Regarding tissue specimens that were fixed for different durations (6 or 24 hours), we observed a significantly smaller mean tissue diameter in specimens fixed for 24 hours versus those fixed for 6 hours for mucosa attached to cartilage (in the 10-mm diameter after-fixation samples), free mucosa (in the 20-mm diameter after-fixation samples), mucosa attached to cartilage (in the 20-mm diameter after-fixation and microscopic measurement samples), and cartilage (in the 20-mm diameter after-fixation samples). Tissue shrinkage was greatest in free mucosal tissue and least in cartilage. CONCLUSION These results should be considered when evaluating patients undergoing surgical procedures for nasal cavity and paranasal sinus malignancies. Surgical margins should be measured before fixation or evaluated if possible before fixation and shrinkage.
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Affiliation(s)
- Leyla Kansu
- Departments of Otolaryngology-Head and Neck Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Erdinç Aydın
- Departments of Otolaryngology-Head and Neck Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Hampar Akkaya
- Departments of Pathology, Başkent University School of Medicine, Ankara, Turkey
| | - Suat Avcı
- Departments of Otolaryngology-Head and Neck Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Nalan Akalın
- Departments of Biochemistry, Başkent University School of Medicine, Ankara, Turkey
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17
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Sarode G, Sarode SC, Shelke P, Patil S. Histopathological assessment of surgical margins of oral carcinomas and related shrinkage of tumour. TRANSLATIONAL RESEARCH IN ORAL ONCOLOGY 2017. [DOI: 10.1177/2057178x17708078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Gargi Sarode
- Department of Oral Pathology and Microbiology, Dr D.Y. Patil Dental College and Hospital, Dr D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr D.Y. Patil Dental College and Hospital, Dr D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Pankaj Shelke
- Department of Oral Pathology and Microbiology, Dr D.Y. Patil Dental College and Hospital, Dr D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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18
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Ahmad I, Gribble A, Murtza I, Ikram M, Pop M, Vitkin A. Polarization image segmentation of radiofrequency ablated porcine myocardial tissue. PLoS One 2017; 12:e0175173. [PMID: 28380013 PMCID: PMC5381909 DOI: 10.1371/journal.pone.0175173] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/21/2017] [Indexed: 11/19/2022] Open
Abstract
Optical polarimetry has previously imaged the spatial extent of a typical radiofrequency ablated (RFA) lesion in myocardial tissue, exhibiting significantly lower total depolarization at the necrotic core compared to healthy tissue, and intermediate values at the RFA rim region. Here, total depolarization in ablated myocardium was used to segment the total depolarization image into three (core, rim and healthy) zones. A local fuzzy thresholding algorithm was used for this multi-region segmentation, and then compared with a ground truth segmentation obtained from manual demarcation of RFA core and rim regions on the histopathology image. Quantitative comparison of the algorithm segmentation results was performed with evaluation metrics such as dice similarity coefficient (DSC = 0.78 ± 0.02 and 0.80 ± 0.02), sensitivity (Sn = 0.83 ± 0.10 and 0.91 ± 0.08), specificity (Sp = 0.76 ± 0.17 and 0.72 ± 0.17) and accuracy (Acc = 0.81 ± 0.09 and 0.71 ± 0.10) for RFA core and rim regions, respectively. This automatic segmentation of parametric depolarization images suggests a novel application of optical polarimetry, namely its use in objective RFA image quantification.
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Affiliation(s)
- Iftikhar Ahmad
- Department of Physics and Applied Mathematics, Pakistan Institute of Engineering and Applied Science (PIEAS), Nilore, Islamabad, Pakistan
- * E-mail:
| | - Adam Gribble
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Division of Biophysics and Bioimaging, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, Canada
| | - Iqbal Murtza
- Department of Computer and Information Sciences, Pakistan Institute of Engineering and Applied Science (PIEAS), Nilore, Islamabad, Pakistan
| | - Masroor Ikram
- Department of Physics and Applied Mathematics, Pakistan Institute of Engineering and Applied Science (PIEAS), Nilore, Islamabad, Pakistan
| | - Mihaela Pop
- Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Alex Vitkin
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Division of Biophysics and Bioimaging, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, 610 University Avenue, Toronto, Ontario Canada
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19
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Wijgman D, ten Wolde B, van Groesen N, Keemers-Gels M, van den Wildenberg F, Strobbe L. Short term safety of oncoplastic breast conserving surgery for larger tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2017; 43:665-671. [DOI: 10.1016/j.ejso.2016.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/17/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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20
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Thekkinkattil D. Evaluation of discrepancies in weights of fresh and fixed specimens in breast surgery: a retrospective cohort study. Gland Surg 2017; 6:27-34. [PMID: 28210549 DOI: 10.21037/gs.2016.09.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Handling of breast specimen is not well monitored and there is limited data on the impact of fixative solutions on specimen weights. Weight of resected breast tissue acts as a guide for future reconstructive and symmetrisation procedures. The aim is to quantitatively evaluate the discrepancies in weight of fresh breast specimen and the weight of specimen after being kept in a fixative solution for a variable length of time. METHODS Single centre retrospective cohort study including patients undergone breast surgery for both diagnostic and therapeutic purposes between January of 2013 and June 2015. Demographic details were collected from case notes, pathology reports and operation room management information system (ORMIS). RESULTS A total of 229 patients with a median age of 63 [interquartile range (IQR) 51-73] years were included. The median body mass index (BMI) was 27.9 (IQR 24.3-31.75) kg/m2. Median weight of the fresh specimens was 104 (IQR 44-535) g and that of fixed specimen was 99 (IQR 43-525) g (P value <0.05, Wilcoxon test). The variation was not unidirectional and factors which were important in influencing this variation were: inclusion of overlying skin and larger specimens (P value <0.05, Mann-Whitney U test). Age, BMI, duration of preservation in fixative solution and density of breast did not have significant influence. CONCLUSIONS Fixative solution does have significant influence on breast specimen weights. This is more pronounced with heavier specimens and those including overlying skin. It is advisable to measure the weight and volume of fresh breast specimen to aid future surgery with best aesthetic outcome.
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Affiliation(s)
- Dinesh Thekkinkattil
- Department of Oncoplastic Breast Surgery, Pilgrim Hospital and Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincolnshire, UK
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21
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Merrill AL, Buckley J, Tang R, Brachtel E, Rai U, Michaelson J, Ly A, Specht MC, Yagi Y, Smith BL. A Study of the Growth Patterns of Breast Carcinoma Using 3D Reconstruction: A Pilot Study. Breast J 2016; 23:83-89. [PMID: 27860134 DOI: 10.1111/tbj.12688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Lumpectomy with microscopically clear margins is a safe and effective approach for surgical management of breast carcinoma. Margins are positive for tumor in 18-50% of lumpectomies, as it is not possible to accurately determine the shape or microscopic borders of a tumor preoperatively or intraoperatively. We examined the 3D microanatomy and growth patterns of common breast carcinoma subtypes to provide guidance for lumpectomy surgery. Prospective consent was obtained for the use of excess tissue from patients undergoing lumpectomy or mastectomy for breast carcinoma. Tissue blocks from nine breast carcinomas were serially sectioned. Hematoxylin and eosin-stained slides at 100 μm intervals were scanned using a Nanozoomer (Hamamatsu, Japan) microscopic-resolution scanner. Three-dimensional reconstructions of tumors were created from scanned images using Reconstruct, open-access software. Breast carcinoma subtypes demonstrated characteristic growth patterns within breast tissue, which may have implications for lumpectomy surgery. Invasive ductal carcinomas showed a spherical shape, with a spiculated surface representing tumor cells infiltrating into surrounding parenchyma. Ductal carcinoma in situ appeared to spread along the duct system, creating dilated, tortuous, tumor-filled ducts. The invasive lobular carcinomas examined had a haphazard, linear, infiltrative growth pattern, different from the shape seen in ductal carcinomas. Our preliminary work suggests that invasive ductal and invasive lobular carcinomas appear to have distinct growth patterns in three dimensions and ductal carcinoma in situ appears to grow in a linear fashion along the duct network. The microanatomy studies described have the potential to guide refinements in breast lumpectomy technique.
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Affiliation(s)
- Andrea L Merrill
- Division of Surgical Oncology, Center for Breast Cancers, Massachusetts General Hospital, Boston, Massachusetts
| | - Julliette Buckley
- Division of Surgical Oncology, Center for Breast Cancers, Massachusetts General Hospital, Boston, Massachusetts
| | - Rong Tang
- Division of Surgical Oncology, Center for Breast Cancers, Massachusetts General Hospital, Boston, Massachusetts
| | - Elena Brachtel
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Upahvan Rai
- Division of Surgical Oncology, Center for Breast Cancers, Massachusetts General Hospital, Boston, Massachusetts
| | - James Michaelson
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle C Specht
- Division of Surgical Oncology, Center for Breast Cancers, Massachusetts General Hospital, Boston, Massachusetts
| | - Yukako Yagi
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Barbara L Smith
- Division of Surgical Oncology, Center for Breast Cancers, Massachusetts General Hospital, Boston, Massachusetts
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22
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Detection of Post-Therapeutic Effects in Breast Carcinoma Using Hard X-Ray Index of Refraction Computed Tomography - A Feasibility Study. PLoS One 2016; 11:e0158306. [PMID: 27362638 PMCID: PMC4928822 DOI: 10.1371/journal.pone.0158306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/13/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives Neoadjuvant chemotherapy is the state-of-the-art treatment in advanced breast cancer. A correct visualization of the post-therapeutic tumor size is of high prognostic relevance. X-ray phase-contrast computed tomography (PC-CT) has been shown to provide improved soft-tissue contrast at a resolution formerly restricted to histopathology, at low doses. This study aimed at assessing ex-vivo the potential use of PC-CT for visualizing the effects of neoadjuvant chemotherapy on breast carcinoma. Materials and Methods The analysis was performed on two ex-vivo formalin-fixed mastectomy samples containing an invasive carcinoma removed from two patients treated with neoadjuvant chemotherapy. Images were matched with corresponding histological slices. The visibility of typical post-therapeutic tissue changes was assessed and compared to results obtained with conventional clinical imaging modalities. Results PC-CT depicted the different tissue types with an excellent correlation to histopathology. Post-therapeutic tissue changes were correctly visualized and the residual tumor mass could be detected. PC-CT outperformed clinical imaging modalities in the detection of chemotherapy-induced tissue alterations including post-therapeutic tumor size. Conclusions PC-CT might become a unique diagnostic tool in the prediction of tumor response to neoadjuvant chemotherapy. PC-CT might be used to assist during histopathological diagnosis, offering a high-resolution and high-contrast virtual histological tool for the accurate delineation of tumor boundaries.
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Risselada M, Mathews KG, Griffith E. The Effect of Specimen Preparation on Post-Excision and Post-Fixation Dimensions, Translation, and Distortion of Canine Cadaver Skin-Muscle-Fascia Specimens. Vet Surg 2016; 45:563-70. [DOI: 10.1111/vsu.12481] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/16/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Marije Risselada
- Department of Clinical Sciences, College of Veterinary Medicine; North Carolina State University; Raleigh North Carolina
| | - Kyle G Mathews
- Department of Clinical Sciences, College of Veterinary Medicine; North Carolina State University; Raleigh North Carolina
| | - Emily Griffith
- Department of Clinical Sciences, College of Veterinary Medicine; North Carolina State University; Raleigh North Carolina
- Department of Statistics, College of Agriculture and Life Sciences; North Carolina State University; Raleigh North Carolina
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Jeyakumar S, Smith AN, Schleis SE, Cattley RC, Tillson DM, Henderson RA. Effect of histologic processing on dimensions of skin samples obtained from cat cadavers. Am J Vet Res 2015; 76:939-45. [DOI: 10.2460/ajvr.76.11.939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Risselada M, Mathews KG, Griffith E. Effect of feline skin specimen preparation on postexcision and postfixation tissue shrinkage. J Feline Med Surg 2015; 18:970-975. [PMID: 26329723 DOI: 10.1177/1098612x15602951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study was performed to assess skin-muscle-fascia specimen shrinkage and donor site changes, and to compare three techniques of specimen preparation for their effect on specimen shrinkage postexcision and after formalin fixation in feline cadaveric specimens. METHODS Fifteen fresh feline cadavers were used for this study. Gelatin spheres were implanted in paired thoracic subcutaneous pockets and subsequently excised with 30 mm lateral margins and a fascial plane as the deep margin. Skin and fascia were either left unsutured, sutured together using four simple interrupted quadrant sutures ('four-quadrant-sutured') or sutured together in a continuous pattern ('circumferentially sutured'). Specimens were measured for tumor-free margins on the excised and fixed specimens. The donor site defect was assessed for enlargement after specimen excision. Statistical analyses were performed to assess the donor site enlargement, and the influence of preparation technique on margin size, with significance set at P <0.05. RESULTS The closest skin margins on the excised and fixed specimens were significantly smaller than the planned 30 mm margins; however, no significant difference was found between postexcision and postfixation specimens. No significant differences were found between the three techniques (P = 0.74) with regard to margins either after excision or fixation. The fascial and skin defects of the donor site were significantly larger than the planned excision. CONCLUSIONS AND RELEVANCE Surgically obtained feline skin-muscle-fascia specimens will significantly decrease in size prior to formalin fixation, resulting in falsely decreased measurements from tumor to tissue margins. Affixing the skin to the fascia does not significantly influence this decrease in margin size in feline tissue specimens at this location.
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Affiliation(s)
- Marije Risselada
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Veterinary Health Complex, Raleigh, NC, USA
| | - Kyle G Mathews
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Veterinary Health Complex, Raleigh, NC, USA
| | - Emily Griffith
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Veterinary Health Complex, Raleigh, NC, USA.,Department of Statistics, College of Agriculture and Life Science, North Carolina State University, Raleigh, NC, USA
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Rominger M, Berg D, Frauenfelder T, Ramaswamy A, Timmesfeld N. Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer? Eur Radiol 2015; 26:1457-65. [DOI: 10.1007/s00330-015-3935-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/19/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
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Risselada M, Mathews KG, Griffith E. Surgically planned versus histologically measured lateral tumor margins for resection of cutaneous and subcutaneous mast cell tumors in dogs: 46 cases (2010–2013). J Am Vet Med Assoc 2015; 247:184-9. [DOI: 10.2460/javma.247.2.184] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Effect of formalin fixation on surgical margins in breast cancer surgical specimen. Int J Breast Cancer 2014; 2014:121838. [PMID: 25349738 PMCID: PMC4202211 DOI: 10.1155/2014/121838] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 07/07/2014] [Accepted: 09/03/2014] [Indexed: 11/17/2022] Open
Abstract
Margin analysis in breast surgery is an important predictor of local recurrence and can have vital impact on the postoperative treatment planning. Objective. The aim was to assess the mean reduction in the closest tumor-free surgical margin in millimeters of breast cancer specimens following formalin fixation. Materials and Methods. We conducted a cross-sectional study at the Aga Khan University Hospital from March 30, 2010 to January 20, 2011. One hundred consecutive breast tumour surgical specimens which had macroscopically visible tumour were included. The cancer type included both in situ and invasive cancers. Excluded were the patients who had previous surgery or systemic/radiation therapy. The closest tumor-free margin was recorded and compared with the margin after formalin fixation. P value of <0.05 was considered significant. Results. The mean age of our 100 patients was 53 years with the majority of the patients having undergone mastectomy for predominantly invasive ductal carcinoma. Following formalin fixation, the mean reduction of the closest tumor-free margin was noted as 2.14 mm which was found statistically significant. Conclusion. Considerable shrinkage of tumor-free surgical margins of breast cancer specimen was noted after formalin fixation. This inference can have implications on the postoperative management plan.
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Mann RM, Bult P, van Laarhoven HWM, Span PN, Schlooz M, Veltman J, Hoogerbrugge N. Breast cancer size estimation with MRI in BRCA mutation carriers and other high risk patients. Eur J Radiol 2013; 82:1416-22. [PMID: 23567481 DOI: 10.1016/j.ejrad.2013.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/02/2013] [Accepted: 03/10/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the value of breast MRI in size assessment of breast cancers in high risk patients, including those with a BRCA 1 or 2 mutation. Guidelines recommend invariably breast MRI screening for these patients and therapy is thus based on these findings. However, the accuracy of breast MRI for staging purposes is only tested in sporadic cancers. METHODS We assessed concordance of radiologic staging using MRI with histopathology in 49 tumors in 46 high risk patients (23 BRCA1, 12 BRCA2 and 11 Non-BRCA patients). The size of the total tumor area (TTA) was compared to pathology. In invasive carcinomas (n=45) the size of the largest focus (LF) was also addressed. RESULTS Correlation of MRI measurements with pathology was 0.862 for TTA and 0.793 for LF. TTA was underestimated in 8(16%), overestimated in 5(10%), and correctly measured in 36(73%) cases. LF was underestimated in 4(9%), overestimated in 5(11%), and correctly measured in 36(80%) cases. Impact of BRCA 1 or 2 mutations on the quality of size estimation was not observed. CONCLUSIONS Tumor size estimation using breast MRI in high risk patients is comparable to its performance in sporadic cancers. Therefore, breast MRI can safely be used for treatment planning.
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Affiliation(s)
- R M Mann
- Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen, The Netherlands.
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Nguyen BT, Deb S, Fox S, Hill P, Collins M, Chua BH. A Prospective Pathologic Study to Define the Clinical Target Volume for Partial Breast Radiation Therapy in Women With Early Breast Cancer. Int J Radiat Oncol Biol Phys 2012; 84:1116-22. [DOI: 10.1016/j.ijrobp.2012.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 11/24/2022]
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Abe H, Shimauchi A, Fan X, River JN, Sattar H, Mueller J, Karczmar GS, Newstead GM. Comparing post-operative human breast specimen radiograph and MRI in lesion margin and volume assessment. J Appl Clin Med Phys 2012; 13:3802. [PMID: 23149773 PMCID: PMC5718530 DOI: 10.1120/jacmp.v13i6.3802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 07/02/2012] [Indexed: 11/23/2022] Open
Abstract
The purpose of this research is to evaluate the potential for identifying malignant breast lesions and their margins on large specimen MRI, in comparison to specimen radiography and clinical dynamic contrast enhanced MRI (DCE‐MRI). Breast specimens were imaged with an MR scanner immediately after surgery, with an IRB‐approved protocol and with the patients' informed consent. Specimen sizes were at least 5 cm in diameter and approximately 1 to 4 cm thick. Coronal and axial gradient echo MR images without fat suppression were acquired over the whole specimens using a 9.4T animal scanner. Findings on specimen MRI were compared with findings on specimen radiograph, and their volumes were compared with measurements obtained from clinical DCE‐MRI. The results showed that invasive ductal carcinoma (IDC) lesions were easily identified using MRI and the margins were clearly distinguishable from nearby tissue. However, ductal carcinoma in situ (DCIS) lesions were not clearly discernible and were diffused with poorly defined margins on MRI. Calcifications associated with DCIS were visualized in all specimens on specimen radiograph. There is a strong correlation between the maximum diameter of lesions as measured by radiograph and MRI (r=0.93), as well as the maximum diameter measured by pathology and radiograph/MRI (r < 0.75). The volumes of IDC measured on specimen MRI were slightly smaller than those measured on DCE‐MRI. Imaging of excised human breast lumpectomy specimens with high magnetic field MRI provides promising results for improvements in lesion identification and margin localization for IDC. However, there are technical challenges in visualization of DCIS lesions. Improvements in specimen imaging are important, as they will provide additional information to standard radiographic analysis. PACS numbers: 87.61.Tg; 87.59.B
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Affiliation(s)
- Hiroyuki Abe
- Department of Radiology, The University of Chicago, Chicago, IL 60637, USA.
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Postma EL, Verkooijen HM, van Esser S, Hobbelink MG, van der Schelling GP, Koelemij R, Witkamp AJ, Contant C, van Diest PJ, Willems SM, Borel Rinkes IHM, van den Bosch MAAJ, Mali WP, van Hillegersberg R. Efficacy of 'radioguided occult lesion localisation' (ROLL) versus 'wire-guided localisation' (WGL) in breast conserving surgery for non-palpable breast cancer: a randomised controlled multicentre trial. Breast Cancer Res Treat 2012; 136:469-78. [PMID: 23053639 DOI: 10.1007/s10549-012-2225-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 08/17/2012] [Indexed: 12/11/2022]
Abstract
For the management of non-palpable breast cancer, accurate pre-operative localisation is essential to achieve complete resection with optimal cosmetic results. Radioguided occult lesions localisation (ROLL) uses the radiotracer, injected intra-tumourally for sentinel lymph node identification to guide surgical excision of the primary tumour. In a multicentre randomised controlled trial, we determined if ROLL is superior to the standard of care (i.e. wire-guided localisation, WGL) for preoperative tumour localisation. Women (>18 years.) with histologically proven non-palpable breast cancer and eligible for breast conserving treatment with sentinel node procedure were randomised to ROLL or WGL. Patients allocated to ROLL received an intra-tumoural dose of 120 Mbq technetium-99 m nanocolloid. The tumour was surgically removed, guided by gamma probe detection. In the WGL group, ultrasound- or mammography-guided insertion of a hooked wire provided surgical guidance for excision of the primary tumour. Primary outcome measures were the proportion of complete tumour excisions (i.e. with negative margins), the proportion of patients requiring re-excision and the volume of tissue removed. Data were analysed according to intention-to-treat principle. This study is registered at ClinincalTrials.gov, number NCT00539474. In total, 314 patients with 316 invasive breast cancers were enrolled. Complete tumour removal with negative margins was achieved in 140/162 (86 %) patients in the ROLL group versus 134/152 (88 %) patients in the WGL group (P = 0.644). Re-excision was required in 19/162 (12 %) patients in the ROLL group versus 15/152 (10 %) (P = 0.587) in the WGL group. Specimen volumes in the ROLL arm were significantly larger than those in the WGL arm (71 vs. 64 cm(3), P = 0.017). No significant differences were seen in the duration and difficulty of the radiological and surgical procedures, the success rate of the sentinel node procedure, and cosmetic outcomes. In this first multicentre randomised controlled comparison of ROLL versus WGL in patients with histologically proven breast cancer, ROLL is comparable to WGL in terms of complete tumour excision and re-excision rates. ROLL, however, leads to excision of larger tissue volumes. Therefore, ROLL cannot replace WGL as the standard of care.
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Affiliation(s)
- E L Postma
- Department of Surgery, University Medical Centre Utrecht, Postbus 85500, 3508 GA, Utrecht, The Netherlands
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McLaughlin RA, Yang X, Quirk BC, Lorenser D, Kirk RW, Noble PB, Sampson DD. Static and dynamic imaging of alveoli using optical coherence tomography needle probes. J Appl Physiol (1985) 2012; 113:967-74. [DOI: 10.1152/japplphysiol.00051.2012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Imaging of alveoli in situ has for the most part been infeasible due to the high resolution required to discern individual alveoli and limited access to alveoli beneath the lung surface. In this study, we present a novel technique to image alveoli using optical coherence tomography (OCT). We propose the use of OCT needle probes, where the distal imaging probe has been miniaturized and encased within a hypodermic needle (as small as 30-gauge, outer diameter 310 μm), allowing insertion deep within the lung tissue with minimal tissue distortion. Such probes enable imaging at a resolution of ∼12 μm within a three-dimensional cylindrical field of view with diameter ∼1.5 mm centered on the needle tip. The imaging technique is demonstrated on excised lungs from three different species: adult rats, fetal sheep, and adult pigs. OCT needle probes were used to image alveoli, small bronchioles, and blood vessels, and results were matched to histological sections. We also present the first dynamic OCT images acquired with an OCT needle probe, allowing tracking of individual alveoli during simulated cyclical lung inflation and deflation.
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Affiliation(s)
- Robert A. McLaughlin
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley, Western Australia, Australia
| | - Xiaojie Yang
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley, Western Australia, Australia
| | - Bryden C. Quirk
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley, Western Australia, Australia
| | - Dirk Lorenser
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley, Western Australia, Australia
| | - Rodney W. Kirk
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley, Western Australia, Australia
| | - Peter B. Noble
- Centre for Neonatal Research and Education, School of Women's and Infants' Health, University of Western Australia, Crawley, Western Australia, Australia; and
| | - David D. Sampson
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley, Western Australia, Australia
- Centre for Microscopy, Characterisation and Analysis, University of Western Australia, Crawley Western Australia, Australia
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Majid S, Tengrup I, Manjer J. Clinical Assessment of Axillary Lymph Nodes and Tumor Size in Breast Cancer Compared with Histopathological Examination: A Population-Based Analysis of 2,537 Women. World J Surg 2012; 37:67-71. [DOI: 10.1007/s00268-012-1788-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yeo BY, McLaughlin RA, Kirk RW, Sampson DD. Enabling freehand lateral scanning of optical coherence tomography needle probes with a magnetic tracking system. BIOMEDICAL OPTICS EXPRESS 2012; 3:1565-78. [PMID: 22808429 PMCID: PMC3395482 DOI: 10.1364/boe.3.001565] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/24/2012] [Accepted: 05/28/2012] [Indexed: 05/20/2023]
Abstract
We present a high-resolution three-dimensional position tracking method that allows an optical coherence tomography (OCT) needle probe to be scanned laterally by hand, providing the high degree of flexibility and freedom required in clinical usage. The method is based on a magnetic tracking system, which is augmented by cross-correlation-based resampling and a two-stage moving window average algorithm to improve upon the tracker's limited intrinsic spatial resolution, achieving 18 µm RMS position accuracy. A proof-of-principle system was developed, with successful image reconstruction demonstrated on phantoms and on ex vivo human breast tissue validated against histology. This freehand scanning method could contribute toward clinical implementation of OCT needle imaging.
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Affiliation(s)
- Boon Y. Yeo
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley WA 6009, Australia
| | - Robert A. McLaughlin
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley WA 6009, Australia
| | - Rodney W. Kirk
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley WA 6009, Australia
| | - David D. Sampson
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley WA 6009, Australia
- Centre for Microscopy, Characterisation & Analysis, University of Western Australia, Crawley WA 6009, Australia
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A novel ‘microscopic method’ of shrinkage calculation in the pursuance of shrinkage based histopathological guidelines for interpretation of surgical margins. Oral Oncol 2012; 48:e15-6. [DOI: 10.1016/j.oraloncology.2012.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 01/21/2012] [Accepted: 01/25/2012] [Indexed: 11/22/2022]
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Keller MD, Vargis E, de Matos Granja N, Wilson RH, Mycek MA, Kelley MC, Mahadevan-Jansen A. Development of a spatially offset Raman spectroscopy probe for breast tumor surgical margin evaluation. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:077006. [PMID: 21806286 PMCID: PMC3144975 DOI: 10.1117/1.3600708] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/06/2011] [Accepted: 05/23/2011] [Indexed: 05/18/2023]
Abstract
The risk of local recurrence for breast cancers is strongly correlated with the presence of a tumor within 1 to 2 mm of the surgical margin on the excised specimen. Previous experimental and theoretical results suggest that spatially offset Raman spectroscopy (SORS) holds much promise for intraoperative margin analysis. Based on simulation predictions for signal-to-noise ratio differences among varying spatial offsets, a SORS probe with multiple source-detector offsets was designed and tested. It was then employed to acquire spectra from 35 frozen-thawed breast tissue samples in vitro. Spectra from each detector ring were averaged to create a composite spectrum with biochemical information covering the entire range from the tissue surface to ∼2 mm below the surface, and a probabilistic classification scheme was used to classify these composite spectra as "negative" or "positive" margins. This discrimination was performed with 95% sensitivity and 100% specificity, or with 100% positive predictive value and 94% negative predictive value.
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Affiliation(s)
- Matthew D Keller
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee 37235, USA
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Palaia I, Bellati F, Calcagno M, Musella A, Perniola G, Panici PB. Invasive vulvar carcinoma and the question of the surgical margin. Int J Gynaecol Obstet 2011; 114:120-3. [PMID: 21669423 DOI: 10.1016/j.ijgo.2011.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 02/27/2011] [Accepted: 02/28/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the discrepancy between width of surgical margin measured with the naked eye/ruler by a surgeon before removing an invasive vulvar carcinoma, and width of margin measured under microscope by pathologist after fixation of the resected lesion with formalin. Potential relationships between discrepancy and disease recurrence were also investigated. METHODS This prospective study was conducted with resected lesions from 86 women who underwent surgery for primary/recurrent invasive vulvar carcinoma. After the surgeon removed the lesions surrounded by 1-2-cm margins, the pathologist determined margin width at the 4 cardinal points of 86 lesions (for a total of 344 margin assessments), first macroscopically and then under the microscope. RESULTS A safety margin of 0.8 cm on microscopic view was achieved in 83% of cases (112 of 135) when the macroscopic measurement was 1cm, in 91% of cases (58 of 64) when it was 1.5 cm, and 98% of cases (105 of 107) when it was 2 cm. CONCLUSION There was a small discrepancy between the surgeon's intent and the microscopic margin measurement, mostly related to tissue shrinkage. A 1-cm surgical margin corresponded to a 0.8-cm margin in microscopic view (the "safe margin") in most cases.
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Affiliation(s)
- Innocenza Palaia
- Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy
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English RE, Li J, Parker AJC, Roskell D, Adams RF, Parulekar V, Baldwin J, Chi Y, Noble JA. A pilot study to evaluate assisted freehand ultrasound elasticity imaging in the sizing of early breast cancer: a comparison of B-mode and AFUSON elasticity ultrasound with histopathology measurements. Br J Radiol 2011; 84:1011-9. [PMID: 21632651 DOI: 10.1259/bjr/13216246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This pilot study investigates the role of assisted-freehand ultrasound (AFUSON) elasticity imaging of the breast in assessing the contour, size and area of 23 early breast cancers by making comparison of AFUSON with the equivalent B-mode ultrasound images and gold standard histopathology slides. METHODS The B-mode, AFUSON and digitised histopathology slides of three early breast cancers were compared for contour, size and area with histopathology scans. AFUSON features that corresponded to areas of known malignant change on the histopathology slides were regarded as diagnostic. These diagnostic criteria were then applied to the B-mode and AFUSON elasticity images of all 23 breast cancers in the pilot study without having the availability of the histopathology scans for reference. Corresponding diameters were measured and the results were compared with the equivalent measurements on the scans of the histology slides. The results were tabulated in histogram form. Diagnostic confidence levels were evaluated. RESULTS Size dimension accuracy increased from 66% using B-mode alone to 82% using combined B-mode and AFUSON elasticity images. Tumour area accuracy was also increased. A small number of cases had a striking visual similarity of shape on AFUSON elasticity scans and histopathology slides. CONCLUSION In spite of the shortfalls in this study, AFUSON elasticity imaging was capable of acquiring some high-quality images that showed strong correlation between AFUSON elasticity and scans of histology slides. Further studies will be carried out to refine the technique and determine if it has a role in the diagnosis and management of breast cancer.
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Affiliation(s)
- R E English
- Oxford Breast Imaging Centre, Oxford Radcliffe Hospitals NHS Trust, Oxford UK.
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Olsha O, Shemesh D, Carmon M, Sibirsky O, Abu Dalo R, Rivkin L, Ashkenazi I. Resection margins in ultrasound-guided breast-conserving surgery. Ann Surg Oncol 2010; 18:447-52. [PMID: 20734147 DOI: 10.1245/s10434-010-1280-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Few published studies have shown the benefits of intraoperative ultrasound in avoiding inadequate margins in breast-conserving surgery. The aim of this study is to quantify intraoperative ultrasound margin size and assess its relationship to tumor size, multifocality, palpability, histology, and presence of intraductal component. METHODS Patients with breast cancer undergoing breast-conserving surgery in whom the operating surgeon visualized the tumor by ultrasound were included. Ultrasound margins measured intraoperatively were prospectively recorded and compared with pathology margins. RESULTS Forty-five patients with 48 tumors were included. Twenty five patients (56%) had palpable tumors. Pathologic mean tumor size was 1.9 cm [95% confidence interval (CI) 1.6-2.2 cm, range 0.5-4.8 cm]. There was good correlation between closest margins recorded by ultrasound and pathology margins (r = 0.4674, P < 0.0008). Fourteen patients (31%) had margins re-excised intraoperatively, 12 of them in the direction of the closest pathological margin. Three patients (7%), all of whom had intraoperative re-excision, had a second operation for involved margins without residual cancer on pathological examination of the reoperative specimens. Ultrasound margins ≥0.5 cm achieved adequate pathology margins of ≥0.2 cm in 95% of margins. Overestimation of pathology margins by ultrasound measurement was significantly affected by multifocality (P = 0.0473). Tumor size, palpability, invasive lobular histology, and presence of ductal carcinoma in situ (DCIS) did not cause significant overestimation of pathology margins by ultrasound. CONCLUSIONS Intraoperative ultrasound may help maintain a low level of reoperation after breast-conserving surgery. Ultrasound margins <0.5 cm should be re-excised intraoperatively. Reliability of ultrasound in predicting the closest pathology margins was diminished in patients with multifocal tumors.
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Affiliation(s)
- Oded Olsha
- Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
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Preclinical evaluation of nuclear morphometry and tissue topology for breast carcinoma detection and margin assessment. Breast Cancer Res Treat 2010; 126:345-54. [PMID: 20446030 DOI: 10.1007/s10549-010-0914-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Abstract
Prevention and early detection of breast cancer are the major prophylactic measures taken to reduce the breast cancer related mortality and morbidity. Clinical management of breast cancer largely relies on the efficacy of the breast-conserving surgeries and the subsequent radiation therapy. A key problem that limits the success of these surgeries is the lack of accurate, real-time knowledge about the positive tumor margins in the surgically excised tumors in the operating room. This leads to tumor recurrence and, hence, the need for repeated surgeries. Current intraoperative techniques such as frozen section pathology or touch imprint cytology severely suffer from poor sampling and non-optimal detection sensitivity. Even though histopathology analysis can provide information on positive tumor margins post-operatively (~2-3 days), this information is of no immediate utility in the operating rooms. In this article, we propose a novel image analysis method for tumor margin assessment based on nuclear morphometry and tissue topology and demonstrate its high sensitivity/specificity in preclinical animal model of breast carcinoma. The method relies on imaging nuclear-specific fluorescence in the excised surgical specimen and on extracting nuclear morphometric parameters (size, number, and area fraction) from the spatial distribution of the observed fluorescence in the tissue. We also report the utility of tissue topology in tumor margin assessment by measuring the fractal dimension in the same set of images. By a systematic analysis of multiple breast tissues specimens, we show here that the proposed method is not only accurate (~97% sensitivity and 96% specificity) in thin sections, but also in three-dimensional (3D) thick tissues that mimic the realistic lumpectomy specimens. Our data clearly precludes the utility of nuclear size as a reliable diagnostic criterion for tumor margin assessment. On the other hand, nuclear area fraction addresses this issue very effectively since it is a combination of both nuclear size and count in any given region of the analyzed image, and thus yields high sensitivity and specificity (~97%) in tumor detection. This is further substantiated by an independent parameter, fractal dimension, based on the tissue topology. Although the basic definition of cancer as an uncontrolled cell growth entails a high nuclear density in tumor regions, a simple but systematic exploration of nuclear distribution in thick tissues by nuclear morphometry and tissue topology as performed in this study has never been carried out, to the best of our knowledge. We discuss the practical aspects of implementing this imaging approach in automated tissue sampling scenario where the accuracy of tumor margin assessment can be significantly increased by scanning the entire surgical specimen rather than sampling only a few sections as in current histopathology analysis.
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Sillah K, Williams LR, Laasch HU, Saleem A, Watkins G, Pritchard SA, Price PM, West CM, Welch IM. Computed tomography overestimation of esophageal tumor length: Implications for radiotherapy planning. World J Gastrointest Oncol 2010; 2:197-204. [PMID: 21160598 PMCID: PMC2999183 DOI: 10.4251/wjgo.v2.i4.197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 02/22/2010] [Accepted: 03/01/2010] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the relationship between preoperative computed tomography (CT) and postoperative pathological measurements of esophageal tumor length and the prognostic significance of CT tumor length data.
METHODS: A retrospective study was carried out in 56 patients who underwent curative esophagogastrectomy. Tumor lengths were measured on the immediate preoperative CT and on the post-operative resection specimens. Inter- and intra-observer variations in CT measurements were assessed. Survival data were collected.
RESULTS: There was a weak correlation between CT and pathological tumor length (r = 0.30, P = 0.025). CT lengths were longer than pathological lengths in 68% (38/56) of patients with a mean difference of 1.67 cm (95% CI: 1.18-2.97). The mean difference in measurements by two radiologists was 0.39 cm (95% CI: -0.59-1.44). The mean difference between repeat CT measured tumor length (intra-observer variation) were 0.04 cm (95% CI: -0.59-0.66) and 0.47 cm (95% CI: -0.53-1.47). When stratified, patients not receiving neoadjuvant chemotherapy showed a strong correlation between CT and pathological tumor length (r = 0.69, P = 0.0014, n = 37) than patients that did (r = 0.13, P = 0.43, n = 19). Median survival with CT tumor length > 5.6 cm was poorer than with smaller tumors, but the difference was not statistically significant.
CONCLUSION: Esophageal tumor length assessed using CT does not reflect pathological tumor extent and should not be the only modality used for management decisions, particularly for planning radiotherapy.
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Affiliation(s)
- Karim Sillah
- Karim Sillah, Ian M Welch, Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
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DeJean P, Brackstone M, Fenster A. An intraoperative 3D ultrasound system for tumor margin determination in breast cancer surgery. Med Phys 2010; 37:564-70. [PMID: 20229864 DOI: 10.1118/1.3290867] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE The purpose of this study was to analyze the clinical utility of a portable three-dimensional ultrasound (3DUS) system to be used for surgical guidance of lumpectomy surgeries. In 11%-60% of lumpectomy surgeries, a second surgery is required to fully resect the tumor. Previous studies have used 3DUS as a guidance tool with the hope of more accuracy in resecting the entire tumor during the first surgery. However, they utilized larger systems, which are not easily integrated into the operating room. METHODS The portable 3DUS scanning system we developed consisted of a motorized "tilt" scanner coupled to a Terason t3000 portable ultrasound machine (Terason Ultrasound, Burlington, MA). The 3DUS system was evaluated by measuring agar "tumor" phantoms of known volumes and acquiring and segmenting images from nine patients undergoing lumpectomy. RESULTS Experiments on simulated agar tumor phantoms have shown that our device could be used to measure objects with smooth, well-defined boundaries of known volume with an error of 3%. It was possible to view and segment estimated tumor margins from the clinical images in three dimensions. Correspondence between measurements obtained in the laboratory and the operating room varied with tumor geometry and the degree of spiculation in the ultrasound image. The measured values obtained by the system did not correspond closely with those obtained using histology. However, a more accurate histological measurement using 3D histology may provide a better basis for comparison. CONCLUSIONS The results of imaging simulated agar tumor phantoms indicate the system's consistency in measuring objects of known volume and geometry. The system could be used for segmenting the approximate boundary of lumpectomy patients' breast tumors relative to inserted guide wires. The potential advantages of this system are a reduction in the number of re-excision surgeries required and a reduction in the operative time with the patient under anesthesia.
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Affiliation(s)
- Paul DeJean
- Imaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5K8, Canada.
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Ha TK, An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S. Missed lesions in synchronous multiple gastric cancer. ANZ J Surg 2010; 80:276-9. [DOI: 10.1111/j.1445-2197.2009.05108.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Imaging of Human Lymph Nodes Using Optical Coherence Tomography: Potential for Staging Cancer. Cancer Res 2010; 70:2579-84. [DOI: 10.1158/0008-5472.can-09-4062] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Littrup PJ, Jallad B, Chandiwala-Mody P, D'Agostini M, Adam BA, Bouwman D. Cryotherapy for breast cancer: a feasibility study without excision. J Vasc Interv Radiol 2010; 20:1329-41. [PMID: 19800542 DOI: 10.1016/j.jvir.2009.06.029] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 05/27/2009] [Accepted: 06/24/2009] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the feasibility of percutaneous multiprobe breast cryoablation (BC) for diverse presentations of cancers that remained in situ after BC. MATERIALS AND METHODS After breast magnetic resonance (MR) imaging and thorough consultation, patients underwent BC after giving informed consent. This study was approved by the institutional review board. In 12 BC sessions, 22 breast cancer foci (stages I-IV) were treated in 11 patients who refused surgery by using multiple 2.4-mm cryoprobes. Five patients had recurrent disease and six had new diagnoses. With use of only local anesthesia, six patients were treated with ultrasonographic (US) guidance and five were treated with both computed tomographic (CT) and US guidance. Saline injections and warming bags were used to protect the skin. Procedure success was defined as 1 cm visible ice beyond all tumor margins. MR imaging and/or clinical follow-up were available for up to 72 months after BC. RESULTS US produced sufficient ice visualization for small tumors, whereas CT helped confirm overall ice extent. The mean pretreatment breast tumor diameter was 1.7 cm +/- 1.2 (range, 0.5-5.8 cm), and an average of 3.1 cryoprobes produced 100% procedural success with mean ice diameters of 5.1 cm +/- 2.2 (range, 2.0-10.0 cm). No significant complications, retraction, or scarring were noted. Biopsies at the margins of the cryoablation site immediately after BC and at follow-up were all negative. No local recurrences have been noted at an average imaging follow-up of 18 months. CONCLUSIONS In conjunction with thorough pre- and postablation MR imaging, CT/US-guided multiprobe BC safely achieved 1 cm visible ice beyond tumor margins with minimal discomfort, good cosmesis, and no short-term local tumor recurrences.
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Affiliation(s)
- Peter J Littrup
- Department of Radiology, Karmanos Cancer Institute, 721 Harper Prof. Bldg Detroit, MI 48201, USA.
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Nykänen M, Kuopio T. Protein and gene expression of estrogen receptor alpha and nuclear morphology of two breast cancer cell lines after different fixation methods. Exp Mol Pathol 2009; 88:265-71. [PMID: 20025868 DOI: 10.1016/j.yexmp.2009.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 12/06/2009] [Accepted: 12/07/2009] [Indexed: 11/26/2022]
Abstract
We assessed morphology and ERalpha protein and gene expression of two breast cancer cell lines after three different fixatives: neutral-buffered 10% formaldehyde, LN-FIX and FineFIX and varying fixation times. We found that the cell morphology was best preserved in cells fixed with LN-FIX. Two commercial fixatives used in this study shrank cells less than formalin. In immunohistochemical assay samples were stained with two different ERalpha antibodies, clone 1D5 and clone SP1. All tested fixatives were suitable for immunohistochemistry. Staining was more intensive and the number of stained cells was larger with the clone 1D5 than with the clone SP1. Our gene expression analysis showed that formalin and LN-FIX preserve the ERalpha better than FineFIX, which is advertised to be optimal for molecular analysis. Our study suggests that tissues fixed with formalin are suitable also for molecular biology assays. This makes possible to research formalin-fixed paraffin-embedded archival tissues also with molecular techniques.
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Affiliation(s)
- Marjukka Nykänen
- Department of Pathology, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
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Verma VP, Kaur N, Agarwal N, Bhargava SK, Singh UR, Saha S, Raheja A. Intra-operative measurement of tumour size in breast cancer and its comparison with other methods: a prospective study. Ecancermedicalscience 2008; 2:96. [PMID: 22275977 PMCID: PMC3234070 DOI: 10.3332/ecancer.2008.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Indexed: 11/16/2022] Open
Abstract
Accurate measurement of breast tumour size determines staging and prognosis. Discrepancies amongst clinical examination (CE), ultrasonography (USG), mammography, pathological examination (PE) and magnetic resonance imaging have been reported. However, few studies have evaluated changes in breast tumour size from the operating table to the laboratory.
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Affiliation(s)
- V P Verma
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi-110095, India
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