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Ratnagobal S, Taylor D, Bourke AG, Kessell M, Madeley C, Robert MC, Vlaskovsky P, Saunders C. Localisation accuracy with iodine-125 seed versus wire guidance for breast cancer surgery. J Med Radiat Sci 2023; 70:218-228. [PMID: 37194479 PMCID: PMC10500114 DOI: 10.1002/jmrs.687] [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: 02/02/2022] [Accepted: 04/21/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Impalpable breast lesions generally require image-guided localisation for breast-conserving surgery. A standard technique is to place a hook wire (HW) within the lesion. Radioguided occult lesion localisation using iodine seeds (ROLLIS) involves inserting a 4.5 mm iodine-125 seed (seed) into the lesion. We hypothesised that a seed could be more precisely positioned in relation to the lesion than a HW and that this may be associated with a lower re-excision rate. METHODS Retrospective review of consecutive participant data from three ROLLIS RCT (ACTRN12613000655741) sites. Participants underwent preoperative lesion localisation (PLL) with seed or HW between September 2013 and December 2017. Lesion and procedural characteristics were recorded. Distances between (1) any part of the seed or thickened segment of the HW ('TSHW') and the lesion/clip ('distance to device' DTD) and (2) centre of the TSHW/seed and centre of the lesion/clip (device centre to target centre 'DCTC') were measured on immediate postinsertion mammograms. Pathological margin involvement and re-excision rates were compared. RESULTS A total of 390 lesions (190 ROLLIS and 200 HWL) were analysed. Lesion characteristics and guidance modality used were similar between groups. Ultrasound-guided DTD and DCTC for seed were smaller than for HW (77.1% and 60.6%, respectively, P-value < 0.001). Stereotactic-guided DCTC for seeds was 41.6% smaller than for HW (P-value = 0.001). No statistically significant difference in the re-excision rates was found. CONCLUSION Iodine-125 seeds can be more precisely positioned for preoperative lesion localisation than HW, however, no statistically significant difference in re-excision rates was detected.
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Affiliation(s)
- Shoba Ratnagobal
- Breast Clinic, Royal Perth HospitalPerthWestern AustraliaAustralia
| | - Donna Taylor
- Breast Clinic, Royal Perth HospitalPerthWestern AustraliaAustralia
- BreastScreen WA, Eastpoint PlazaPerthWestern AustraliaAustralia
- Medical SchoolThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Anita G. Bourke
- BreastScreen WA, Eastpoint PlazaPerthWestern AustraliaAustralia
- Medical SchoolThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Breast Centre, Sir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - Meredith Kessell
- Breast Clinic, Royal Perth HospitalPerthWestern AustraliaAustralia
| | - Carolyn Madeley
- BreastScreen WA, Eastpoint PlazaPerthWestern AustraliaAustralia
| | - Melanie C. Robert
- BreastScreen WA, Eastpoint PlazaPerthWestern AustraliaAustralia
- Breast Centre, Fiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Philip Vlaskovsky
- Medical SchoolThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Biostatistical UnitRoyal Perth Hospital Research FoundationPerthWestern AustraliaAustralia
| | - Christobel Saunders
- Breast Clinic, Royal Perth HospitalPerthWestern AustraliaAustralia
- Medical SchoolThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Breast Centre, Fiona Stanley HospitalMurdochWestern AustraliaAustralia
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Taylor DB, Bourke AG, Westcott EJ, Marinovich ML, Chong CYL, Liang R, Hughes RL, Elder E, Saunders CM. Surgical outcomes after radioactive 125I seed versus hookwire localization of non-palpable breast cancer: a multicentre randomized clinical trial. Br J Surg 2021; 108:40-48. [PMID: 33640932 PMCID: PMC10364908 DOI: 10.1093/bjs/znaa008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/19/2020] [Accepted: 08/30/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous studies have suggested improved efficiency and patient outcomes with 125I seed compared with hookwire localization (HWL) in breast-conserving surgery, but high-level evidence of superior surgical outcomes is lacking. The aim of this multicentre pragmatic RCT was to compare re-excision and positive margin rates after localization using 125I seed or hookwire in women with non-palpable breast cancer. METHODS Between September 2013 and March 2018, women with non-palpable breast cancer eligible for breast-conserving surgery were assigned randomly to preoperative localization using 125I seeds or hookwires. Randomization was stratified by lesion type (pure ductal carcinoma in situ (DCIS) or other) and study site. Primary endpoints were rates of re-excision and margin positivity. Secondary endpoints were resection volumes and weights. RESULTS A total of 690 women were randomized at eight sites; 659 women remained after withdrawal (125I seed, 327; HWL, 332). Mean age was 60.3 years in the 125I seed group and 60.7 years in the HWL group, with no difference between the groups in preoperative lesion size (mean 13.2 mm). Lesions were pure DCIS in 25.9 per cent. The most common radiological lesion types were masses (46.9 per cent) and calcifications (28.2 per cent). The localization modality was ultrasonography in 65.5 per cent and mammography in 33.7 per cent. The re-excision rate after 125I seed localization was significantly lower than for HWL (13.9 versus 18.9 per cent respectively; P = 0.019). There were no significant differences in positive margin rates, or in specimen weights and volumes. CONCLUSION Re-excision rates after breast-conserving surgery were significantly lower after 125I seed localization compared with HWL. Registration number: ACTRN12613000655741 (http://www.ANZCTR.org.au/).
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Affiliation(s)
- D B Taylor
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.,BreastScreen WA, Perth, Western Australia, Australia
| | - A G Bourke
- Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.,BreastScreen WA, Perth, Western Australia, Australia.,Breast Centre, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia
| | - E J Westcott
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia.,School of Physics, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - M L Marinovich
- School of Public Health, Curtin University, Bentley, Perth, Western Australia, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - C Y L Chong
- Monash Health School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - R Liang
- Department of Surgery, Gold Coast Hospital and Health Service, Robina, Queensland, Australia
| | - R L Hughes
- Radiology Department, Waikato District Health Board, Hamilton, New Zealand
| | - E Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Sydney, New South Wales, Australia
| | - C M Saunders
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.,Breast Centre, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia.,Department of Surgery, St John of God Hospital, Subiaco, Perth, Western Australia, Australia
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3
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Powell M, Gate T, Kalake O, Ranjith C, Pennick MO. Magnetic Seed Localization (Magseed) for excision of impalpable breast lesions-The North Wales experience. Breast J 2021; 27:529-536. [PMID: 33855763 DOI: 10.1111/tbj.14232] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
The breast surgical community has faced huge challenges due to close working relationships with radiologists who are in short supply. Breast lesion localization is moving away from the traditional wire technique, which requires an on-site radiologist to support theater scheduling. In North Wales, the introduction of Magseed for impalpable breast lesion localization has facilitated theater scheduling in the absence of same day radiology presence. We audited our first 200 Magseed cases to assess the safety and efficacy of the technique, the ease of use, and patient experience. Data were entered prospectively into an excel data base relating to Magseed cases. Data collected included demographics, pre and postoperative lesion size, histology, margin positivity, and re-excision rates. Data were submitted in real time by the radiologist performing Magseed insertion to ascertain degree of difficulty. A PROMS questionnaire was designed and sent to patients undergoing Magseed vs wire localizations. Two hundred patients underwent Magseed-guided wide local excision between May 2018 and January 2020 across 2 district general hospital sites in North Wales. Histology: 69% IDC, 20% ILC, and 11% others. Mean preoperative size 12.3 mm, postoperative size 19 mm. Re-excision rate 15%. Re-excision for DCIS was significantly more likely than for invasive disease (p < 0.0001). A significant difference was also observed between radiological mean preoperative tumor size estimate and actual histological tumor size in patients undergoing margin re-excision (p = 0.000019). Wire-guided re-excision rate was 21% in the same unit. PROMs found the procedure well tolerated by patients. Surgeons and radiologists reported Magseed to be user-friendly with minimal learning curve. Magseed use for impalpable breast lesion localization is safe, user friendly, and well tolerated by patients. It produces favorable re-excision rates when compared to published figures for wire-guided excision. The presence of DCIS and preoperative radiological size underestimation was associated with margin re-excision.
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Affiliation(s)
- Meena Powell
- Department of Breast Radiology, Wrexham Maelor Hospital, Wrexham, UK
| | - Tim Gate
- Department of Breast Surgery, Wrexham Maelor Hospital, Wrexham, UK
| | - Onneile Kalake
- Department of Breast Surgery, Glan Clwyd Hospital, Denbighshire, UK
| | - Carmen Ranjith
- Department of Breast Surgery, Glan Clwyd Hospital, Denbighshire, UK
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Foo KY, Kennedy KM, Zilkens R, Allen WM, Fang Q, Sanderson RW, Anstie J, Dessauvagie BF, Latham B, Saunders CM, Chin L, Kennedy BF. Optical palpation for tumor margin assessment in breast-conserving surgery. BIOMEDICAL OPTICS EXPRESS 2021; 12:1666-1682. [PMID: 33796380 PMCID: PMC7984801 DOI: 10.1364/boe.415888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Intraoperative margin assessment is needed to reduce the re-excision rate of breast-conserving surgery. One possibility is optical palpation, a tactile imaging technique that maps stress (force applied across the tissue surface) as an indicator of tissue stiffness. Images (optical palpograms) are generated by compressing a transparent silicone layer on the tissue and measuring the layer deformation using optical coherence tomography (OCT). This paper reports, for the first time, the diagnostic accuracy of optical palpation in identifying tumor within 1 mm of the excised specimen boundary using an automated classifier. Optical palpograms from 154 regions of interest (ROIs) from 71 excised tumor specimens were obtained. An automated classifier was constructed to predict the ROI margin status by first choosing a circle diameter, then searching for a location within the ROI where the circle was ≥ 75% filled with high stress (indicating a positive margin). A range of circle diameters and stress thresholds, as well as the impact of filtering out non-dense tissue regions, were tested. Sensitivity and specificity were calculated by comparing the automated classifier results with the true margin status, determined from co-registered histology. 83.3% sensitivity and 86.2% specificity were achieved, compared to 69.0% sensitivity and 79.0% specificity obtained with OCT alone on the same dataset using human readers. Representative optical palpograms show that positive margins containing a range of cancer types tend to exhibit higher stress compared to negative margins. These results demonstrate the potential of optical palpation for margin assessment.
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Affiliation(s)
- Ken Y. Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Kelsey M. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
| | - Wes M. Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Rowan W. Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - James Anstie
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Benjamin F. Dessauvagie
- School of Medicine, The University of Western Australia, Perth, Australia
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Christobel M. Saunders
- School of Medicine, The University of Western Australia, Perth, Australia
- Breast Centre, Fiona Stanley Hospital, Murdoch, Australia
- Breast Clinic, Royal Perth Hospital, Perth, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies, Perth, Australia
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5
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Lamb LR, Mercaldo S, Oseni TO, Bahl M. Predictors of Reexcision following Breast-Conserving Surgery for Ductal Carcinoma In Situ. Ann Surg Oncol 2020; 28:1390-1397. [PMID: 32914389 DOI: 10.1245/s10434-020-09101-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reexcision following breast-conserving surgery (BCS) in women with ductal carcinoma in situ (DCIS) results in adjuvant treatment delays, higher health care costs, and undesirable cosmetic outcomes. The purpose of this study is to determine patient, imaging, pathological, and surgical predictors of reexcision following BCS for DCIS. PATIENTS AND METHODS A retrospective review of women with DCIS who had BCS from 2007 to 2016 was conducted. Patient, imaging, pathological, and surgical features, in addition to surgical outcomes, were collected from medical records. Standard statistical tests were used to compare features between patients who did and did not undergo at least one reexcision. A multivariable logistic regression model was fit to assess features associated with reexcision. RESULTS A total of 547 women (mean age 59 years; range 30-88 years) diagnosed with DCIS at core needle biopsy underwent BCS. Of all women, 31.6% (173/547) had at least one reexcision. With multivariable analysis, features associated with reexcision included younger patient age (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.97-1.0, p = 0.049), African-American race (aOR 2.66, 95% CI 1.13-6.26, p = 0.03), biopsy modality of ultrasound (aOR 2.35, 95% CI 1.22-4.53, p = 0.01), and earlier year of surgery (aOR 0.92, 95% CI 0.86-0.98, p = 0.01). No pathological features of DCIS were associated with reexcision risk. CONCLUSIONS In our cohort of nearly 550 women with DCIS who underwent BCS, 31.6% had at least one reexcision. Features associated with reexcision include younger patient age, African-American race, biopsy modality of ultrasound, and earlier year of surgery.
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Affiliation(s)
- Leslie R Lamb
- Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Mercaldo
- Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tawakalitu O Oseni
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Manisha Bahl
- Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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6
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Perera N, Bourke AG. The technique and accuracy of breast specimen ultrasound in achieving clear margins in breast conserving surgery. J Med Imaging Radiat Oncol 2020; 64:747-755. [DOI: 10.1111/1754-9485.13077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Natalie Perera
- School of Medicine The University of Western Australia Perth Western Australia Australia
| | - Anita G Bourke
- School of Medicine The University of Western Australia Perth Western Australia Australia
- Breast Centre Department of Diagnostic and Interventional Radiology Sir Charles Gairdner Hospital Perth Western Australia Australia
- BreastScreen WA Perth Western Australia Australia
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7
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Fang Q, Frewer L, Zilkens R, Krajancich B, Curatolo A, Chin L, Foo KY, Lakhiani DD, Sanderson RW, Wijesinghe P, Anstie JD, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Handheld volumetric manual compression-based quantitative microelastography. JOURNAL OF BIOPHOTONICS 2020; 13:e201960196. [PMID: 32057188 DOI: 10.1002/jbio.201960196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 05/20/2023]
Abstract
Compression optical coherence elastography (OCE) typically requires a mechanical actuator to impart a controlled uniform strain to the sample. However, for handheld scanning, this adds complexity to the design of the probe and the actuator stroke limits the amount of strain that can be applied. In this work, we present a new volumetric imaging approach that utilizes bidirectional manual compression via the natural motion of the user's hand to induce strain to the sample, realizing compact, actuator-free, handheld compression OCE. In this way, we are able to demonstrate rapid acquisition of three-dimensional quantitative microelastography (QME) datasets of a tissue volume (6 × 6 × 1 mm3 ) in 3.4 seconds. We characterize the elasticity sensitivity of this freehand manual compression approach using a homogeneous silicone phantom and demonstrate comparable performance to a benchtop mounted, actuator-based approach. In addition, we demonstrate handheld volumetric manual compression-based QME on a tissue-mimicking phantom with an embedded stiff inclusion and on freshly excised human breast specimens from both mastectomy and wide local excision (WLE) surgeries. Tissue results are coregistered with postoperative histology, verifying the capability of our approach to measure the elasticity of tissue and to distinguish stiff tumor from surrounding soft benign tissue.
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Affiliation(s)
- Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Luke Frewer
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Brooke Krajancich
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Andrea Curatolo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
- Optics and Biophotonics Group, Visual Instituto de Óptica "Daza de Valdés," Consejo Superior de Investigaciones Cientificas (IO, CSIC), Madrid, Spain
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Ken Y Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Devina D Lakhiani
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Rowan W Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Philip Wijesinghe
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
- School of Physics and Astronomy (SUPA), University of St Andrews, St Andrews, UK
| | - James D Anstie
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Benjamin F Dessauvagie
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Christobel M Saunders
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
- Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, Australia
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Brendan F Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies, Western Australia, Australia
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8
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Foo KY, Chin L, Zilkens R, Lakhiani DD, Fang Q, Sanderson R, Dessauvagie BF, Latham B, McLaren S, Saunders CM, Kennedy BF. Three-dimensional mapping of the attenuation coefficient in optical coherence tomography to enhance breast tissue microarchitecture contrast. JOURNAL OF BIOPHOTONICS 2020; 13:e201960201. [PMID: 32141243 DOI: 10.1002/jbio.201960201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/16/2020] [Accepted: 03/04/2020] [Indexed: 06/10/2023]
Abstract
Effective intraoperative tumor margin assessment is needed to reduce re-excision rates in breast-conserving surgery (BCS). Mapping the attenuation coefficient in optical coherence tomography (OCT) throughout a sample to create an image (attenuation imaging) is one promising approach. For the first time, three-dimensional OCT attenuation imaging of human breast tissue microarchitecture using a wide-field (up to ~45 × 45 × 3.5 mm) imaging system is demonstrated. Representative results from three mastectomy and one BCS specimen (from 31 specimens) are presented with co-registered postoperative histology. Attenuation imaging is shown to provide substantially improved contrast over OCT, delineating nuanced features within tumors (including necrosis and variations in tumor cell density and growth patterns) and benign features (such as sclerosing adenosis). Additionally, quantitative micro-elastography (QME) images presented alongside OCT and attenuation images show that these techniques provide complementary contrast, suggesting that multimodal imaging could increase tissue identification accuracy and potentially improve tumor margin assessment.
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Affiliation(s)
- Ken Y Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Devina D Lakhiani
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Rowan Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Benjamin F Dessauvagie
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Sally McLaren
- PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Christobel M Saunders
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
- Breast Centre, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Brendan F Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies, Perth, Western Australia, Australia
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9
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Madeley C, Kessell M, Madeley C, Taylor D. A comparison of stereotactic and tomosynthesis-guided localisation of impalpable breast lesions. J Med Radiat Sci 2019; 66:170-176. [PMID: 31347295 PMCID: PMC6745377 DOI: 10.1002/jmrs.348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 05/23/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Impalpable breast cancers require precise pre-operative lesion localisation to minimise re-excision rates. Conventional techniques include hookwire insertion using stereotactic guidance. Newer techniques include the use of tomosynthesis guidance and the use of iodine-125 seeds. This study compares the accuracy of lesion localisation with hookwire or seed insertion using prone stereotactic or upright tomosynthesis guidance. METHODS This registered quality improvement activity did not require formal ethics approval. The post-localisation images for 116 lesions were reviewed. The distance from the lesion or breast biopsy marker to the hookwire or seed was measured on post-insertion mammograms. The relative placement accuracy of hookwire or seed using prone stereotactic or upright tomosynthesis guidance was compared. A lesion to seed or wire distance > 10 mm was considered technically unsatisfactory. RESULTS 94.8% of the seeds and wires inserted via prone stereotactic guidance were accurately placed, compared with 89.6% of those inserted via upright tomosynthesis. There were twice as many technically unsatisfactory insertions under upright tomosynthesis guidance. The majority of the unsatisfactory insertions using upright tomosynthesis occurred when the lesion was at or below the level of the nipple and the insertion was performed craniocaudally. CONCLUSION The degree of accuracy of pre-operative localisation of impalpable breast lesions is significantly higher with the use of prone stereotactic rather than upright tomosynthesis guidance. This was most evident with the placement of I-125 seeds, and in cases where the target lesion was located below the level of the nipple.
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Affiliation(s)
- Carolyn Madeley
- Department of Diagnostic and Interventional RadiologyRoyal Perth HospitalPerthWestern AustraliaAustralia
- Breast Screen Western AustraliaPerthWestern AustraliaAustralia
| | - Meredith Kessell
- Department of Diagnostic and Interventional RadiologyRoyal Perth HospitalPerthWestern AustraliaAustralia
| | | | - Donna Taylor
- Department of Diagnostic and Interventional RadiologyRoyal Perth HospitalPerthWestern AustraliaAustralia
- Medical School, Faculty of Health and Medical SciencesUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
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Fang Q, Krajancich B, Chin L, Zilkens R, Curatolo A, Frewer L, Anstie JD, Wijesinghe P, Hall C, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Handheld probe for quantitative micro-elastography. BIOMEDICAL OPTICS EXPRESS 2019; 10:4034-4049. [PMID: 31452993 PMCID: PMC6701559 DOI: 10.1364/boe.10.004034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 05/13/2023]
Abstract
Optical coherence elastography (OCE) has been proposed for a range of clinical applications. However, the majority of these studies have been performed using bulky, lab-based imaging systems. A compact, handheld imaging probe would accelerate clinical translation, however, to date, this had been inhibited by the slow scan rates of compact devices and the motion artifact induced by the user's hand. In this paper, we present a proof-of-concept, handheld quantitative micro-elastography (QME) probe capable of scanning a 6 × 6 × 1 mm volume of tissue in 3.4 seconds. This handheld probe is enabled by a novel QME acquisition protocol that incorporates a custom bidirectional scan pattern driving a microelectromechanical system (MEMS) scanner, synchronized with the sample deformation induced by an annular PZT actuator. The custom scan pattern reduces the total acquisition time and the time difference between B-scans used to generate displacement maps, minimizing the impact of motion artifact. We test the feasibility of the handheld QME probe on a tissue-mimicking silicone phantom, demonstrating comparable image quality to a bench-mounted setup. In addition, we present the first handheld QME scans performed on human breast tissue specimens. For each specimen, quantitative micro-elastograms are co-registered with, and validated by, histology, demonstrating the ability to distinguish stiff cancerous tissue from surrounding soft benign tissue.
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Affiliation(s)
- Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Brooke Krajancich
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Currently with Department of Electrical Engineering, Stanford University, Stanford 94305, USA
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Andrea Curatolo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Currently with Visual Optics and Biophotonics Group, Instituto de Óptica “Daza de Valdés”, Consejo Superior de Investigaciones Cientificas (IO, CSIC), C/Serrano, 121, Madrid 28006, Spain
| | - Luke Frewer
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - James D. Anstie
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Philip Wijesinghe
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Currently with SUPA, School of Physics and Astronomy, University of St Andrews, North Haugh, St Andrews, KY16 9SS, UK
| | - Colin Hall
- Future Industries Institute, University of South Australia, Mawson Lakes, South Australia, 5095, Australia
| | - Benjamin F. Dessauvagie
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
| | - Christobel M. Saunders
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia, 6000, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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11
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Sanderson RW, Curatolo A, Wijesinghe P, Chin L, Kennedy BF. Finger-mounted quantitative micro-elastography. BIOMEDICAL OPTICS EXPRESS 2019; 10:1760-1773. [PMID: 31086702 PMCID: PMC6484987 DOI: 10.1364/boe.10.001760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 05/14/2023]
Abstract
We present a finger-mounted quantitative micro-elastography (QME) probe, capable of measuring the elasticity of biological tissue in a format that avails of the dexterity of the human finger. Finger-mounted QME represents the first demonstration of a wearable elastography probe. The approach realizes optical coherence tomography-based elastography by focusing the optical beam into the sample via a single-mode fiber that is fused to a length of graded-index fiber. The fiber is rigidly affixed to a 3D-printed thimble that is mounted on the finger. Analogous to manual palpation, the probe compresses the tissue through the force exerted by the finger. The resulting deformation is measured using optical coherence tomography. Elasticity is estimated as the ratio of local stress at the sample surface, measured using a compliant layer, to the local strain in the sample. We describe the probe fabrication method and the signal processing developed to achieve accurate elasticity measurements in the presence of motion artifact. We demonstrate the probe's performance in motion-mode scans performed on homogeneous, bi-layer and inclusion phantoms and its ability to measure a thermally-induced increase in elasticity in ex vivo muscle tissue. In addition, we demonstrate the ability to acquire 2D images with the finger-mounted probe where lateral scanning is achieved by swiping the probe across the sample surface.
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Affiliation(s)
- Rowan W. Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Andrea Curatolo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Current address: Visual Optics and Biophotonics Group, Instituto de Óptica “Daza de Valdés”, Consejo Superior de Investigaciones Cientificas (IO, CSIC), C/Serrano, 121, Madrid 28006, Spain
| | - Philip Wijesinghe
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Current address: SUPA, School of Physics and Astronomy, University of St. Andrews, KY16 9SS, UK
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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12
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Allen WM, Wijesinghe P, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Optical palpation for the visualization of tumor in human breast tissue. JOURNAL OF BIOPHOTONICS 2019; 12:e201800180. [PMID: 30054979 DOI: 10.1002/jbio.201800180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/20/2018] [Accepted: 07/26/2018] [Indexed: 05/17/2023]
Abstract
Accurate and effective removal of tumor in one operation is an important goal of breast-conserving surgery. However, it is not always achieved. Surgeons often utilize manual palpation to assess the surgical margin and/or the breast cavity. Manual palpation, however, is subjective and has relatively low resolution. Here, we investigate a tactile imaging technique, optical palpation, for the visualization of tumor. Optical palpation generates maps of the stress at the surface of tissue under static preload compression. Stress is evaluated by measuring the deformation of a contacting thin compliant layer with known mechanical properties using optical coherence tomography. In this study, optical palpation is performed on 34 freshly excised human breast specimens. Wide field-of-view (up to ~46 × 46 mm) stress images, optical palpograms, are presented from four representative specimens, demonstrating the capability of optical palpation to visualize tumor. Median stress reported for adipose tissue, 4 kPa, and benign dense tissue, 8 kPa, is significantly lower than for invasive tumor, 60 kPa. In addition, we demonstrate that optical palpation provides contrast consistent with a related optical technique, quantitative micro-elastography. This study demonstrates that optical palpation holds promise for visualization of tumor in breast-conserving surgery.
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Affiliation(s)
- Wes M Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Philip Wijesinghe
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Benjamin F Dessauvagie
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Christobel M Saunders
- Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Breast Centre, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Brendan F Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
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13
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Tran Q, Mizumoto R, Tran M, Reintals M, Gounder V. Carbon-track localisation as an adjunct to wire-guided excision of impalpable breast lesions: A retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Allen WM, Foo KY, Zilkens R, Kennedy KM, Fang Q, Chin L, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Clinical feasibility of optical coherence micro-elastography for imaging tumor margins in breast-conserving surgery. BIOMEDICAL OPTICS EXPRESS 2018; 9:6331-6349. [PMID: 31065432 PMCID: PMC6491020 DOI: 10.1364/boe.9.006331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/26/2018] [Accepted: 11/08/2018] [Indexed: 05/08/2023]
Abstract
It has been demonstrated that optical coherence micro-elastography (OCME) provides additional contrast of tumor compared to optical coherence tomography (OCT) alone. Previous studies, however, have predominantly been performed on mastectomy specimens. Such specimens typically differ substantially in composition and geometry from the more clinically relevant wide-local excision (WLE) specimens excised during breast-conserving surgery. As a result, it remains unclear if the mechanical contrast observed is maintained in WLE specimens. In this manuscript, we begin to address this issue by performing a feasibility study of OCME on 17 freshly excised, intact WLE specimens. In addition, we present two developments required to sustain the progression of OCME towards intraoperative deployment. First, to enable the rapid visualization of en face images required for intraoperative assessment, we describe an automated segmentation algorithm to fuse en face micro-elastograms with OCT images to provide dual contrast images. Secondly, to validate contrast in micro-elastograms, we present a method that enables co-registration of en face images with histology of WLE specimens, sectioned in the orthogonal plane, without any modification to the standard clinical workflow. We present a summary of the observations across the 17 specimens imaged in addition to representative micro-elastograms and OCT images demonstrating contrast in a number of tumor margins, including those involved by invasive ductal carcinoma, mucinous carcinoma, and solid-papillary carcinoma. The results presented here demonstrate the potential of OCME for imaging tumor margins.
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Affiliation(s)
- Wes M. Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Ken Y. Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Kelsey M. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Current address: Department of Biomedical Engineering, Columbia University, 622 W 168th St, New York, NY 10025, USA
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Benjamin F. Dessauvagie
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
| | - Christobel M. Saunders
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia, 6000, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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15
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Clement Z, McLeay W, Hoffmann C, Shin P, Chowdhry M, Eaton M. Re-excision rate after sector resection for breast cancer: A 5-year retrospective cohort study. Breast Dis 2018; 38:7-13. [PMID: 30198861 DOI: 10.3233/bd-180339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Positive margins after Breast conserving surgery (BCS) for breast cancer can result in local recurrence (LR) requiring further surgery. This can lead to unnecessary patient anxiety, poor prognosis and impose additional economic burden to our health system. The aim of this study is to assess the rate of re-excision for positive margins after BCS using the sector resection technique. METHODS This single centre retrospective cohort study included all women who underwent BCS using sector resection between the years of 2012 and 2016. A total of 456 patients underwent sector resection. We evaluated the margin status, re-excision rates and their predictive risk factors. RESULTS 415 (91%) patients had clear margins. 41 (9%) patients underwent further re-excision for positive or close margin. 75.6% of those patients had DCIS and 51% had invasive carcinoma involving the margins. Patient and tumour characteristics associated with an increased risk of positive margin were women under the age of 50 (p = 0.19), tumours >50 mm (p = 0.001), grade-2 (p = 0.48) and grade-3 (p = 0.63), HER-2 positivity (p = 0.02), sentinel lymph node positivity (p = 0.03), and patients undergoing axillary lymph node dissection (p = 0.01). CONCLUSION BCS using the sector resection technique has a low re-excision rate for positive margins. Younger patients and aggressive tumour biology are important predictive risk factors for positive margins.
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Affiliation(s)
- Zackariah Clement
- Breast and Endocrine Surgery Unit, Flinders Medical Centre, Adelaide, Australia
| | - William McLeay
- Breast and Endocrine Surgery Unit, Flinders Medical Centre, Adelaide, Australia
| | - Clive Hoffmann
- Breast and Endocrine Surgery Unit, Flinders Medical Centre, Adelaide, Australia
| | - Peter Shin
- Breast and Endocrine Surgery Unit, Flinders Medical Centre, Adelaide, Australia
| | - Munir Chowdhry
- Breast and Endocrine Surgery Unit, Flinders Medical Centre, Adelaide, Australia
| | - Michael Eaton
- Breast and Endocrine Surgery Unit, Flinders Medical Centre, Adelaide, Australia.,Medical School, Flinders University, Adelaide, Australia
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Allen WM, Kennedy KM, Fang Q, Chin L, Curatolo A, Watts L, Zilkens R, Chin SL, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Wide-field quantitative micro-elastography of human breast tissue. BIOMEDICAL OPTICS EXPRESS 2018; 9:1082-1096. [PMID: 29541505 PMCID: PMC5846515 DOI: 10.1364/boe.9.001082] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 05/18/2023]
Abstract
Currently, 20-30% of patients undergoing breast-conserving surgery require a second surgery due to insufficient surgical margins in the initial procedure. We have developed a wide-field quantitative micro-elastography system for the assessment of tumor margins. In this technique, we map tissue elasticity over a field-of-view of ~46 × 46 mm. We performed wide-field quantitative micro-elastography on thirteen specimens of freshly excised tissue acquired from patients undergoing a mastectomy. We present wide-field optical coherence tomography (OCT) images, qualitative (strain) micro-elastograms and quantitative (elasticity) micro-elastograms, acquired in 10 minutes. We demonstrate that wide-field quantitative micro-elastography can extend the range of tumors visible using OCT-based elastography by providing contrast not present in either OCT or qualitative micro-elastography and, in addition, can reduce imaging artifacts caused by a lack of contact between tissue and the imaging window. Also, we describe how the combined evaluation of OCT, qualitative micro-elastograms and quantitative micro-elastograms can improve the visualization of tumor.
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Affiliation(s)
- Wes M. Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Kelsey M. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Andrea Curatolo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Lucinda Watts
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Synn Lynn Chin
- Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
| | - Benjamin F. Dessauvagie
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- School of Pathology and Laboratory Medicine, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
| | - Christobel M. Saunders
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia, 6000, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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17
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Ong JS, Teh J, Saunders C, Bourke AG, Lizama C, Newton J, Phillips M, Taylor DB. Patient satisfaction with Radioguided Occult Lesion Localisation using iodine-125 seeds (‘ROLLIS’) versus conventional hookwire localisation. Eur J Surg Oncol 2017; 43:2261-2269. [DOI: 10.1016/j.ejso.2017.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/31/2017] [Accepted: 09/13/2017] [Indexed: 12/01/2022] Open
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18
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Chin L, Latham B, Saunders CM, Sampson DD, Kennedy BF. Simplifying the assessment of human breast cancer by mapping a micro-scale heterogeneity index in optical coherence elastography. JOURNAL OF BIOPHOTONICS 2017; 10:690-700. [PMID: 27618159 DOI: 10.1002/jbio.201600092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/08/2016] [Accepted: 08/13/2016] [Indexed: 05/02/2023]
Abstract
Surgical treatment of breast cancer aims to identify and remove all malignant tissue. Intraoperative assessment of tumor margins is, however, not exact; thus, re-excision is frequently needed, or excess normal tissue is removed. Imaging methods applicable intraoperatively could help to reduce re-excision rates whilst minimizing removal of excess healthy tissue. Optical coherence elastography (OCE) has been proposed for use in breast-conserving surgery; however, intraoperative interpretation of complex OCE images may prove challenging. Observations of breast cancer on multiple length scales, by OCE, ultrasound elastography, and atomic force microscopy, have shown an increase in the mechanical heterogeneity of malignant breast tumors compared to normal breast tissue. In this study, a micro-scale mechanical heterogeneity index is introduced and used to form heterogeneity maps from OCE scans of 10 ex vivo human breast tissue samples. Through comparison of OCE, optical coherence tomography images, and corresponding histology, malignant tissue is shown to possess a higher heterogeneity index than benign tissue. The heterogeneity map simplifies the contrast between tumor and normal stroma in breast tissue, facilitating the rapid identification of possible areas of malignancy, which is an important step towards intraoperative margin assessment using OCE.
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Affiliation(s)
- Lixin Chin
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, 6 Verdun St, Nedlands, Perth, WA 6009, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Robin Warren Drive, Murdoch, WA 6150, Australia
| | - Christobel M Saunders
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
| | - David D Sampson
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- Centre for Microscopy, Characterisation & Analysis, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Brendan F Kennedy
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, 6 Verdun St, Nedlands, Perth, WA 6009, Australia
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19
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Allen WM, Chin L, Wijesinghe P, Kirk RW, Latham B, Sampson DD, Saunders CM, Kennedy BF. Wide-field optical coherence micro-elastography for intraoperative assessment of human breast cancer margins. BIOMEDICAL OPTICS EXPRESS 2016; 7:4139-4153. [PMID: 27867721 PMCID: PMC5102536 DOI: 10.1364/boe.7.004139] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/20/2016] [Accepted: 08/24/2016] [Indexed: 05/18/2023]
Abstract
Incomplete excision of malignant tissue is a major issue in breast-conserving surgery, with typically 20 - 30% of cases requiring a second surgical procedure arising from postoperative detection of an involved margin. We report advances in the development of a new intraoperative tool, optical coherence micro-elastography, for the assessment of tumor margins on the micro-scale. We demonstrate an important step by conducting whole specimen imaging in intraoperative time frames with a wide-field scanning system acquiring mosaicked elastograms with overall dimensions of ~50 × 50 mm, large enough to image an entire face of most lumpectomy specimens. This capability is enabled by a wide-aperture annular actuator with an internal diameter of 65 mm. We demonstrate feasibility by presenting elastograms recorded from freshly excised human breast tissue, including from a mastectomy, lumpectomies and a cavity shaving.
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Affiliation(s)
- Wes M. Allen
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, 6 Verdun Street, Nedlands, WA 6009, Australia
| | - Lixin Chin
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, 6 Verdun Street, Nedlands, WA 6009, Australia
| | - Philip Wijesinghe
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Rodney W. Kirk
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- Centre for Nanoscale BioPhotonics, Faculty of Health Science, University of Adelaide, Adelaide, SA 5005, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
| | - David D. Sampson
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- Centre for Microscopy, Characterisation & Analysis, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Christobel M. Saunders
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
- Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
| | - Brendan F. Kennedy
- Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, 6 Verdun Street, Nedlands, WA 6009, Australia
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Bourke AG, Taylor DB, Westcott E, Hobbs M, Saunders C. Iodine-125 seeds to guide removal of impalpable breast lesions: radio-guided occult lesion localization - a pilot study. ANZ J Surg 2016; 87:E178-E182. [DOI: 10.1111/ans.13460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Anita G. Bourke
- Sir Charles Gairdner Hospital; Perth Western Australia Australia
- School of Surgery; University of Western Australia; Perth Western Australia Australia
- BreastScreen WA; Perth Western Australia Australia
| | - Donna B. Taylor
- School of Surgery; University of Western Australia; Perth Western Australia Australia
- BreastScreen WA; Perth Western Australia Australia
- Royal Perth Hospital; Perth Western Australia Australia
| | - Eliza Westcott
- Sir Charles Gairdner Hospital; Perth Western Australia Australia
- School of Physics; University of Western Australia; Perth Western Australia Australia
| | - Max Hobbs
- Royal Perth Hospital; Perth Western Australia Australia
| | - Christobel Saunders
- School of Surgery; University of Western Australia; Perth Western Australia Australia
- Royal Perth Hospital; Perth Western Australia Australia
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21
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Taylor DB, Bourke AG, Westcott E, Burrage J, Latham B, Riley P, Ballal H, Kamyab R, Frost F, Dissanayake D, Landman J, Phillips M, Saunders C. Radioguided occult lesion localisation using iodine‐125 seeds (‘
ROLLIS
’) for removal of impalpable breast lesions: First
A
ustralian experience. J Med Imaging Radiat Oncol 2015; 59:411-420. [DOI: 10.1111/1754-9485.12302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Donna B. Taylor
- School of SurgeryUniversity of Western Australia Perth Western Australia Australia
- Department of RadiologyRoyal Perth Hospital Perth Western Australia Australia
| | - Anita G. Bourke
- School of SurgeryUniversity of Western Australia Perth Western Australia Australia
- Breast CentreDepartment of RadiologySir Charles Gairdner Hospital Perth Western Australia Australia
| | - Eliza Westcott
- Department of Medical Technology and PhysicsSir Charles Gairdner HospitalQEII Medical Centre Perth Western Australia Australia
- School of PhysicsUniversity of Western Australia Perth Western Australia Australia
| | - John Burrage
- Department of Medical Engineering and PhysicsRoyal Perth Hospital Perth Western Australia Australia
| | - Bruce Latham
- PathWest Laboratory MedicineRoyal Perth Hospitial Perth Western Australia Australia
- School of MedicineNotre Dame University Fremantle Western Australia Australia
| | - Paul Riley
- Breast CentreDepartment of RadiologySir Charles Gairdner Hospital Perth Western Australia Australia
| | - Helen Ballal
- Breast CentreDepartment of RadiologySir Charles Gairdner Hospital Perth Western Australia Australia
| | - Roshi Kamyab
- Breast CentreDepartment of RadiologySir Charles Gairdner Hospital Perth Western Australia Australia
| | - Felicity Frost
- PathWest Laboratory MedicineQEII Medical Centre Perth Western Australia Australia
| | - Deepthi Dissanayake
- Department of RadiologyRoyal Perth Hospital Perth Western Australia Australia
| | - Joanne Landman
- Department of Nuclear MedicineRoyal Perth Hospital Perth Western Australia Australia
| | - Michael Phillips
- Harry Perkins Institute for Medical ResearchUniversity of Western Australia Perth Western Australia Australia
| | - Christobel Saunders
- School of SurgeryUniversity of Western Australia Perth Western Australia Australia
- Department of RadiologyRoyal Perth Hospital Perth Western Australia Australia
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