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Liu W, Zhang E, Zhang M. Current Application of Navigation Systems in Robotic-Assisted and Laparoscopic Partial Nephrectomy: Focus on the Improvement of Surgical Performance and Outcomes. Ann Surg Oncol 2024; 31:2163-2172. [PMID: 38063985 DOI: 10.1245/s10434-023-14716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/20/2023] [Indexed: 01/09/2024]
Abstract
Kidney cancer represents the third most prevalent malignancy among all types of genitourinary cancer worldwide. Currently, there is a growing trend of employing partial nephrectomy for the management of large and complex tumors. Surgical outcomes are associated with some amendable surgical factors, including warm ischemic time, pedicle clamping, preserved volume of renal parenchyma, appropriate surgical strategy, and precise resection of the tumor. Improving surgical performance is pivotal for achieving favorable surgical outcomes. Due to advancements in imaging visualization technology and the shift of the medical paradigm toward precision medicine, an increasing number of navigation systems have been implemented in partial nephrectomy procedures. The navigation system can assist surgeons in formulating optimal surgical strategies and enhance the safety, precision, and feasibility of resecting complex renal tumors. In this review, we provide an overview of currently available navigation systems and their feasible applications, with a focus on how they contribute to the improvement of surgical performance and outcomes during robotic-assisted and laparoscopic partial nephrectomy.
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Affiliation(s)
- Wangmin Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Enchong Zhang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Mo Zhang
- Department of Urology, The First Hospital of China Medical University, Shenyang, China.
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2
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G K AV, Gogoi G, Kachappilly MC, Rangarajan A, Pandya HJ. Label-free multimodal electro-thermo-mechanical (ETM) phenotyping as a novel biomarker to differentiate between normal, benign, and cancerous breast biopsy tissues. J Biol Eng 2023; 17:68. [PMID: 37957665 PMCID: PMC10644568 DOI: 10.1186/s13036-023-00388-y] [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: 05/06/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Technologies for quick and label-free diagnosis of malignancies from breast tissues have the potential to be a significant adjunct to routine diagnostics. The biophysical phenotypes of breast tissues, such as its electrical, thermal, and mechanical properties (ETM), have the potential to serve as novel markers to differentiate between normal, benign, and malignant tissue. RESULTS We report a system-of-biochips (SoB) integrated into a semi-automated mechatronic system that can characterize breast biopsy tissues using electro-thermo-mechanical sensing. The SoB, fabricated on silicon using microfabrication techniques, can measure the electrical impedance (Z), thermal conductivity (K), mechanical stiffness (k), and viscoelastic stress relaxation (%R) of the samples. The key sensing elements of the biochips include interdigitated electrodes, resistance temperature detectors, microheaters, and a micromachined diaphragm with piezoresistive bridges. Multi-modal ETM measurements performed on formalin-fixed tumour and adjacent normal breast biopsy samples from N = 14 subjects were able to differentiate between invasive ductal carcinoma (malignant), fibroadenoma (benign), and adjacent normal (healthy) tissues with a root mean square error of 0.2419 using a Gaussian process classifier. Carcinoma tissues were observed to have the highest mean impedance (110018.8 ± 20293.8 Ω) and stiffness (0.076 ± 0.009 kNm-1) and the lowest thermal conductivity (0.189 ± 0.019 Wm-1 K-1) amongst the three groups, while the fibroadenoma samples had the highest percentage relaxation in normalized load (47.8 ± 5.12%). CONCLUSIONS The work presents a novel strategy to characterize the multi-modal biophysical phenotype of breast biopsy tissues to aid in cancer diagnosis from small-sized tumour samples. The methodology envisions to supplement the existing technology gap in the analysis of breast tissue samples in the pathology laboratories to aid the diagnostic workflow.
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Affiliation(s)
- Anil Vishnu G K
- Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore, Karnataka, 560012, India
| | - Gayatri Gogoi
- Department of Pathology, Assam Medical College, Dibrugarh, Assam, 786002, India
| | - Midhun C Kachappilly
- Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, Karnataka, 560012, India
| | - Annapoorni Rangarajan
- Department of Developmental Biology and Genetics, Indian Institute of Science, Bangalore, Karnataka, 560012, India
| | - Hardik J Pandya
- Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, Karnataka, 560012, India.
- Centre for Product Design and Manufacturing, Indian Institute of Science, Bangalore, Karnataka, 560012, India.
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3
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Barbora A, Karri S, Firer MA, Minnes R. Multifractal analysis of cellular ATR-FTIR spectrum as a method for identifying and quantifying cancer cell metastatic levels. Sci Rep 2023; 13:18935. [PMID: 37919384 PMCID: PMC10622493 DOI: 10.1038/s41598-023-46014-1] [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: 05/18/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023] Open
Abstract
Cancer is a leading cause of mortality today. Sooner a cancer is detected, the more effective is the treatment. Histopathological diagnosis continues to be the gold standard worldwide for cancer diagnosis, but the methods used are invasive, time-consuming, insensitive, and still rely to some degree on the subjective judgment of pathologists. Recent research demonstrated that Attenuated Total Reflection-Fourier Transform Infrared (ATR-FTIR) spectroscopy can be used to determine the metastatic potential of cancer cells by evaluating their membrane hydration. In the current study, we demonstrate that the conversion of ATR-FTIR spectra using multifractal transformation generates a unique number for each cell line's metastatic potential. Applying this technique to murine and human cancer cells revealed a correlation between the metastatic capacity of cancer cells within the same lineage and higher multifractal value. The multifractal spectrum value was found to be independent of the cell concentration used in the assay and unique to the tested lineage. Healthy cells exhibited a smaller multifractal spectrum value than cancer cells. Further, the technique demonstrated the ability to detect cancer progression by being sensitive to the proportional change between healthy and cancerous cells in the sample. This enables precise determination of cancer metastasis and disease progression independent of cell concentration by comparing the measured spectroscopy derived multifractal spectrum value. This quick and simple technique devoid of observer bias can transform cancer diagnosis to a great extent improving public health prognosis worldwide.
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Affiliation(s)
- Ayan Barbora
- Department of Physics, Ariel University, 40700, Ariel, Israel
| | - Sirish Karri
- Department of Chemical Engineering, Ariel University, 40700, Ariel, Israel
| | - Michael A Firer
- Department of Chemical Engineering, Ariel University, 40700, Ariel, Israel
- Adelson School of Medicine, Ariel University, 40700, Ariel, Israel
- Ariel Center for Applied Cancer Research, Ariel University, 40700, Ariel, Israel
| | - Refael Minnes
- Department of Physics, Ariel University, 40700, Ariel, Israel.
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Ilhan B, Bademler S, Kılıç B, Onder S, Karanlık H. The impact of intraoperative cavity shaving on re-excision rates in breast-conserving surgery. J Surg Oncol 2023; 127:527-534. [PMID: 36434747 DOI: 10.1002/jso.27149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES This trial aimed to investigate the effects of circumferential shaving on reducing the reoperation rates during breast-conserving surgery (BCS). METHODS In the study, before 2014, 404 (39.9%) breast cancers (BCs) out of a total of 1012 BCs underwent BCS without intraoperative cavity shaving (ICS) and constituted the no-ICS group. After this date, ICS was added to 608 (60.1%) BCSs (ICS group) and intraoperative margin analysis was not requested from pathologists during these second BCS procedures. RESULTS The patient and BC characteristics in the no-ICS and ICS groups were similar. Carcinoma detection at the margin and reoperation rates were 13.9% in the no-ICS group and 7.6% in the ICS group (p = 0.001). No significant difference was detected between patients who underwent BCS with intraoperative frozen section analysis (FSA) and patients who underwent BCS with additional ICS (5.6% vs. 7.6%, p = 0.383). CONCLUSIONS ICS decreased the rates of positive margins and reoperations among patients with BCS to an acceptable level compared with intraoperative FSA. It may be concluded that ICS is feasible to achieve BC margin control.
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Affiliation(s)
- Burak Ilhan
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Suleyman Bademler
- Department of Surgery, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Berkay Kılıç
- Department of Surgery, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasan Karanlık
- Department of Surgery, Oncology Institute, Istanbul University, Istanbul, Turkey
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Pradipta AR, Tanaka K. Application of Acrolein Imines to Organic Synthesis, Biofunctional Studies, and Clinical Practice. CHEM REC 2021; 21:646-662. [PMID: 33769681 DOI: 10.1002/tcr.202000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/10/2021] [Indexed: 11/12/2022]
Abstract
N-alkyl unsaturated imines derived from acrolein, a toxin produced during oxidative stress, and biogenic alkyl amines occur naturally and are considered biologically relevant compounds. However, despite the recent conceptual and technological advances in organic synthesis, research on the new reactivity of these compounds is lacking. This personal account discusses research on the reactivity that has been overlooked in acrolein imines, including the discovery of new methods to synthesize biologically active compounds, the determination of new functions of relevant imines and their precursors, i. e., aldehydes and amines, and the application of these methods for clinical diagnosis.
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Affiliation(s)
- Ambara R Pradipta
- School of Materials and Chemical Technology, Department of Chemical Science and Engineering, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo, 152-8552, Japan
| | - Katsunori Tanaka
- School of Materials and Chemical Technology, Department of Chemical Science and Engineering, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo, 152-8552, Japan.,Biofunctional Synthetic Chemistry Laboratory, Cluster for Pioneering Research, RIKEN 2-1 Hirosawa, Wako, Saitama, 351-0198, Japan.,Biofunctional Chemistry Laboratory, A. Butlerov Institute of Chemistry, Kazan Federal University, 18 Kremlyovskaya Street, Kazan, 420008, Russian Federation
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Pradipta AR, Tanei T, Morimoto K, Shimazu K, Noguchi S, Tanaka K. Emerging Technologies for Real-Time Intraoperative Margin Assessment in Future Breast-Conserving Surgery. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:1901519. [PMID: 32382473 PMCID: PMC7201251 DOI: 10.1002/advs.201901519] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/16/2020] [Accepted: 02/14/2020] [Indexed: 05/23/2023]
Abstract
Clean surgical margins in breast-conserving surgery (BCS) are essential for preventing recurrence. Intraoperative pathologic diagnostic methods, such as frozen section analysis and imprint cytology, have been recognized as crucial tools in BCS. However, the complexity and time-consuming nature of these pathologic procedures still inhibit their broader applicability worldwide. To address this situation, two issues should be considered: 1) the development of nonpathologic intraoperative diagnosis methods that have better sensitivity, specificity, speed, and cost; and 2) the promotion of new imaging algorithms to standardize data for analyzing positive margins, as represented by artificial intelligence (AI), without the need for judgment by well-trained pathologists. Researchers have attempted to develop new methods or techniques; several have recently emerged for real-time intraoperative management of breast margins in live tissues. These methods include conventional imaging, spectroscopy, tomography, magnetic resonance imaging, microscopy, fluorescent probes, and multimodal imaging techniques. This work summarizes the traditional pathologic and newly developed techniques and discusses the advantages and disadvantages of each method. Taking into consideration the recent advances in analyzing pathologic data from breast cancer tissue with AI, the combined use of new technologies with AI algorithms is proposed, and future directions for real-time intraoperative margin assessment in BCS are discussed.
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Affiliation(s)
- Ambara R. Pradipta
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
- School of Materials and Chemical TechnologyDepartment of Chemical Science and EngineeringTokyo Institute of Technology2‐12‐1 Ookayama, Meguro‐kuTokyo152‐8552Japan
| | - Tomonori Tanei
- Department of Breast and Endocrine SurgeryGraduate School of MedicineOsaka University2‐2‐E10 Yamadaoka, SuitaOsaka565‐0871Japan
| | - Koji Morimoto
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
| | - Kenzo Shimazu
- Department of Breast and Endocrine SurgeryGraduate School of MedicineOsaka University2‐2‐E10 Yamadaoka, SuitaOsaka565‐0871Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine SurgeryGraduate School of MedicineOsaka University2‐2‐E10 Yamadaoka, SuitaOsaka565‐0871Japan
| | - Katsunori Tanaka
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
- School of Materials and Chemical TechnologyDepartment of Chemical Science and EngineeringTokyo Institute of Technology2‐12‐1 Ookayama, Meguro‐kuTokyo152‐8552Japan
- Biofunctional Chemistry LaboratoryA. Butlerov Institute of ChemistryKazan Federal University18 Kremlyovskaya StreetKazan420008Russia
- GlycoTargeting Research LaboratoryRIKEN Baton Zone Program2‐1 HirosawaWakoSaitama351‐0198Japan
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Tanei T, Pradipta AR, Morimoto K, Fujii M, Arata M, Ito A, Yoshida M, Saigitbatalova E, Kurbangalieva A, Ikeda J, Morii E, Noguchi S, Tanaka K. Cascade Reaction in Human Live Tissue Allows Clinically Applicable Diagnosis of Breast Cancer Morphology. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1801479. [PMID: 30693189 PMCID: PMC6343070 DOI: 10.1002/advs.201801479] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/31/2018] [Indexed: 05/30/2023]
Abstract
Clean operating margins in breast cancer surgery are important for preventing recurrence. However, the current methods for determining margins such as intraoperative frozen section analysis or imprint cytology are not satisfactory since they are time-consuming and cause a burden on the patient and on hospitals with a limited accuracy. A "click-to-sense" probe is developed based on the detection of acrolein, which is a substance released by oxidatively stressed cancer cells and can be visualized under fluorescence microscopy. Using live breast tissues resected from breast cancer patients, it is demonstrated that this method can quickly, selectively, and sensitively differentiate cancer lesion from normal breast gland or benign proliferative lesions. Since acrolein is accumulated in all types of cancers, this method could be used to quickly assess the surgical margins in other types of cancer.
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Affiliation(s)
- Tomonori Tanei
- Department of Breast and Endocrine SurgeryGraduate School of MedicineOsaka University2‐2‐E10 YamadaokaSuitaOsaka565‐0871Japan
| | - Ambara R. Pradipta
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
| | - Koji Morimoto
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
- Osaka Women's Junior College3‐8‐1 KasugaokaFujiideraOsaka583‐8558Japan
| | - Motoko Fujii
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
| | - Mayumi Arata
- Seed Compounds Exploratory Unit for Drug Discovery PlatformRIKEN Center for Sustainable Resource Science2‐1 HirosawaWakoSaitama351‐0198Japan
| | - Akihiro Ito
- Chemical Genomics Research GroupRIKEN Center for Sustainable Resource Science2‐1 HirosawaWakoSaitama351‐0198Japan
- School of Life SciencesTokyo University of Pharmacy and Life Sciences1432‐1 HorinouchiHachiojiTokyo192‐0392Japan
| | - Minoru Yoshida
- Seed Compounds Exploratory Unit for Drug Discovery PlatformRIKEN Center for Sustainable Resource Science2‐1 HirosawaWakoSaitama351‐0198Japan
- Chemical Genomics Research GroupRIKEN Center for Sustainable Resource Science2‐1 HirosawaWakoSaitama351‐0198Japan
| | - Elena Saigitbatalova
- Biofunctional Chemistry LaboratoryA. Butlerov Institute of ChemistryKazan Federal University18 Kremlyovskaya StreetKazan420008Russian Federation
| | - Almira Kurbangalieva
- Biofunctional Chemistry LaboratoryA. Butlerov Institute of ChemistryKazan Federal University18 Kremlyovskaya StreetKazan420008Russian Federation
| | - Jun‐ichiro Ikeda
- Department of Pathology (C3)Graduate School of MedicineOsaka University2‐2 YamadaokaSuitaOsaka565‐0871Japan
| | - Eiichi Morii
- Department of Pathology (C3)Graduate School of MedicineOsaka University2‐2 YamadaokaSuitaOsaka565‐0871Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine SurgeryGraduate School of MedicineOsaka University2‐2‐E10 YamadaokaSuitaOsaka565‐0871Japan
| | - Katsunori Tanaka
- Biofunctional Synthetic Chemistry LaboratoryRIKEN Cluster for Pioneering Research2‐1 HirosawaWakoSaitama351‐0198Japan
- GlycoTargeting Research LaboratoryRIKEN Baton Zone Program2‐1 HirosawaWakoSaitama351‐0198Japan
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Heidkamp J, Zusterzeel PL, van Engen‐van Grunsven AC, Overduin CG, Veltien A, Maat A, Rovers MM, Fütterer JJ. MRI evaluation of vulvar squamous-cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor-free margins. NMR IN BIOMEDICINE 2019; 32:e4025. [PMID: 30431192 PMCID: PMC6587990 DOI: 10.1002/nbm.4025] [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] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/30/2018] [Accepted: 09/19/2018] [Indexed: 06/09/2023]
Abstract
In the surgical treatment of vulvar squamous-cell carcinoma (VSCC), tumor-free margins of 8 mm or more are considered adequate. However, limited perioperative information on the tumor-free margins other than the surgeon's own estimation is available. The purpose of this study was therefore to investigate the feasibility of ex vivo MRI in localizing VSCC and to assess the surgical tumor-free margins in fresh radical local excision (RLE) specimens to guide the surgeon during resections. Nine patients with biopsy-proven VSCC scheduled for RLE were prospectively included. Intact fresh specimens were scanned using a 7 T preclinical MR-scanner. Whole mount H&E-stained slides were obtained every 3 mm and correlated with ex vivo MRI. A pathologist annotated VSCC and minimal tumor-free margins (3 o'clock, 9 o'clock, basal) on the digitalized histological slides. An observer with knowledge of histology (the non-blinded annotation) and a radiologist blinded to histology (the blinded annotation) separately performed annotation of the same features on ex vivo MRI. Linear correlation and agreement of the ex vivo MRI measurements with histology were assessed. Diagnostic performance for VSCC localization and identification of margins less than 8 mm was expressed as positive and negative predictive values (PPV, NPV). In 153 matched ex vivo MRI slices, the observer correctly identified 79/91 margins as less than 8 mm (PPV 87%) and 110/124 margins as 8 mm or greater (NPV 89%). The radiologist correctly annotated absence of VSCC in 73/81 (NPV 90%) and presence in 65/72 (PPV 90%) slices. Sixty-four of 90 margins were correctly identified as less than 8 mm (PPV 71%) and 83/102 margins as 8 mm or greater (NPV 81%). Both non-blinded and blinded annotations were linearly correlated and demonstrated good agreement with histology. Accurate localization of VSCC and measurements of the surgical tumor-free margins in fresh RLE specimens using ex vivo MRI seems feasible. High diagnostic performance in VSCC localization and identification of margins less than 8 mm suggest ex vivo MRI to be clinically applicable.
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Affiliation(s)
- Jan Heidkamp
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Petra L.M. Zusterzeel
- Department of Obstetrics and GynaecologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Christiaan G. Overduin
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Andor Veltien
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Arie Maat
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Maroeska M. Rovers
- Department of Operating RoomsRadboud University Medical CenterNijmegenThe Netherlands
| | - Jurgen J. Fütterer
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
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Intraoperative Imaging Techniques to Support Complete Tumor Resection in Partial Nephrectomy. Eur Urol Focus 2018; 4:960-968. [DOI: 10.1016/j.euf.2017.04.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/29/2017] [Indexed: 12/22/2022]
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Evaluation of tongue squamous cell carcinoma resection margins using ex-vivo MR. Int J Comput Assist Radiol Surg 2017; 12:821-828. [PMID: 28130702 PMCID: PMC5420007 DOI: 10.1007/s11548-017-1524-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/06/2017] [Indexed: 01/13/2023]
Abstract
Purpose Purpose of this feasibility study was (1) to evaluate whether application of ex-vivo 7T MR of the resected tongue specimen containing squamous cell carcinoma may provide information on the resection margin status and (2) to evaluate the research and developmental issues that have to be solved for this technique to have the beneficial impact on clinical outcome that we expect: better oncologic and functional outcomes, better quality of life, and lower costs. Methods We performed a non-blinded validation of ex-vivo 7T MR to detect the tongue squamous cell carcinoma and resection margin in 10 fresh tongue specimens using histopathology as gold standard. Results In six of seven specimens with a histopathologically determined invasion depth of the tumor of \documentclass[12pt]{minimal}
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\begin{document}$${\ge }3$$\end{document}≥3 mm, the tumor could be recognized on MR, with a resection margin within a 2 mm range as compared to histopathology. In three specimens with an invasion depth of \documentclass[12pt]{minimal}
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\begin{document}$${<}1$$\end{document}<1 mm, the tumor was not visible on MR. Technical limitations mainly included scan time, image resolution, and the fact that we used a less available small-bore 7T MR machine. Conclusion Ex-vivo 7T probably will have a low negative predictive value but a high positive predictive value, meaning that in tumors thicker than a few millimeters we expect to be able to predict whether the resection margin is too small. A randomized controlled trial needs to be performed to show our hypothesis: better oncologic and functional outcomes, better quality of life, and lower costs.
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Gray RJ, Pockaj BA, Garvey E, Blair S. Intraoperative Margin Management in Breast-Conserving Surgery: A Systematic Review of the Literature. Ann Surg Oncol 2017; 25:18-27. [PMID: 28058560 DOI: 10.1245/s10434-016-5756-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast surgeons have a wide variety of intraoperative techniques available to help achieve low rates for positive margins of excision, with variable levels of evidence. METHODS A systematic review of the medical literature from 1995 to July 2016 was conducted, with 434 abstracts identified and evaluated. The analysis included 106 papers focused on intraoperative management of breast cancer margins and contained actionable data. RESULTS Ultrasound-guided lumpectomy for palpable tumors, as an alternative to palpation guidance, can lower positive margin rates, but the effect when used as an alternative to wire localization (WL) for nonpalpable tumors is less certain. Localization techniques such as radioactive seed localization and radioguided occult lesion localization were found potentially to lower positive margin rates as alternatives to WL depending on baseline positive margin rates. Intraoperative pathologic methods including gross histology, frozen section analysis, and imprint cytology all have the potential to lower the rates of positive margins. Cavity-shave margins and the Marginprobe device both lower rates of positive margins, with some potential for negative cosmetic effects. Specimen radiography and multiple miscellaneous techniques did not affect positive margin rates or provided too little evidence for formation of a conclusion. CONCLUSIONS A systematic review of the literature showed evidence that several intraoperative techniques and actions can lower the rates of positive margins. These results are presented together with graded recommendations.
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Affiliation(s)
| | | | - Erin Garvey
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Sarah Blair
- UCSD Department of Surgery, UCSD Cancer Center, Encinitas, USA
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