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Khazaei K, Roshandel P, Parastar H. Visible-short wavelength near infrared hyperspectral imaging coupled with multivariate curve resolution-alternating least squares for diagnosis of breast cancer. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2025; 324:124966. [PMID: 39153346 DOI: 10.1016/j.saa.2024.124966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/26/2024] [Accepted: 08/10/2024] [Indexed: 08/19/2024]
Abstract
This study investigates the application of visible-short wavelength near-infrared hyperspectral imaging (Vis-SWNIR HSI) in the wavelength range of 400-950 nm and advanced chemometric techniques for diagnosing breast cancer (BC). The research involved 56 ex-vivo samples encompassing both cancerous and non-cancerous breast tissue from females. First, HSI images were analyzed using multivariate curve resolution-alternating least squares (MCR-ALS) to exploit pure spatial and spectral profiles of active components. Then, the MCR-ALS resolved spatial profiles were arranged in a new data matrix for exploration and discrimination between benign and cancerous tissue samples using principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA). The PLS-DA classification accuracy of 82.1 % showed the potential of HSI and chemometrics for non-invasive detection of BC. Additionally, the resolved spectral profiles by MCR-ALS can be used to track the changes in the breast tissue during cancer and treatment. It is concluded that the proposed strategy in this work can effectively differentiate between cancerous and non-cancerous breast tissue and pave the way for further studies and potential clinical implementation of this innovative approach, offering a promising avenue for improving early detection and treatment outcomes in BC patients.
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Affiliation(s)
- Kazhal Khazaei
- Department of Chemistry, Sharif University of Technology, P.O. Box 11155-9516, Tehran, Iran
| | - Pegah Roshandel
- Department of Chemistry, Sharif University of Technology, P.O. Box 11155-9516, Tehran, Iran
| | - Hadi Parastar
- Department of Chemistry, Sharif University of Technology, P.O. Box 11155-9516, Tehran, Iran.
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2
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Dowling GP, Hehir CM, Daly GR, Hembrecht S, Keelan S, Giblin K, Alrawashdeh MM, Boland F, Hill ADK. Diagnostic accuracy of intraoperative methods for margin assessment in breast cancer surgery: A systematic review & meta-analysis. Breast 2024; 76:103749. [PMID: 38759577 PMCID: PMC11127275 DOI: 10.1016/j.breast.2024.103749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE There are a wide variety of intraoperative techniques available in breast surgery to achieve low rates for positive margins of excision. The objective of this systematic review was to determine the pooled diagnostic accuracy of intraoperative breast margin assessment techniques that have been evaluated in clinical practice. METHODS This study was performed in accordance with PRISMA guidelines. A systematic search of the literature was conducted to identify studies assessing the diagnostic accuracy of intraoperative margin assessment techniques. Only clinical studies with raw diagnostic accuracy data as compared with final permanent section histopathology were included in the meta-analysis. A bivariate model for diagnostic meta-analysis was used to determine overall pooled sensitivity and specificity. RESULTS Sixty-one studies were eligible for inclusion in this systematic review and meta-analysis. Cytology demonstrated the best diagnostic accuracy, with pooled sensitivity of 0.92 (95 % CI 0.77-0.98) and a pooled specificity of 0.95 (95 % CI 0.90-0.97). The findings also indicate good diagnostic accuracy for optical spectroscopy, with a pooled sensitivity of 0.86 (95 % CI 0.76-0.93) and a pooled specificity of 0.92 (95 % CI 0.82-0.97). CONCLUSION Pooled data indicate that optical spectroscopy, cytology and frozen section have the greatest diagnostic accuracy of currently available intraoperative margin assessment techniques. However, long turnaround time for results and their resource intensive nature has prevented widespread adoption of these methods. The aim of emerging technologies is to compete with the diagnostic accuracy of these established techniques, while improving speed and usability.
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Affiliation(s)
- Gavin P Dowling
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland.
| | - Cian M Hehir
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Gordon R Daly
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Sandra Hembrecht
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Stephen Keelan
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Katie Giblin
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Maen M Alrawashdeh
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Arnold D K Hill
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
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3
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Kopicky L, Fan B, Valente SA. Intraoperative evaluation of surgical margins in breast cancer. Semin Diagn Pathol 2024:S0740-2570(24)00065-0. [PMID: 38965021 DOI: 10.1053/j.semdp.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/12/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
Achieving clear resection margins at the time of lumpectomy is essential for optimal patient outcomes. Margin status is traditionally determined by pathologic evaluation of the specimen and often is difficult or impossible for the surgeon to definitively know at the time of surgery, resulting in the need for re-operation to obtain clear surgical margins. Numerous techniques have been investigated to enhance the accuracy of intraoperative margin and are reviewed in this manuscript.
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Affiliation(s)
- Lauren Kopicky
- Division of Breast Surgical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Betty Fan
- Department of Breast Surgery, University of Chicago, Chicago, IL, USA
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Ahmed S, Hulsman L, Roth D, Fisher C, Ludwig K, Imeokparia FO, VonDerHaar RJ, Lester ME, Hassanein AH. Evaluating Operative Times for Intraoperative Conversion of Axillary Node Biopsy to Axillary Lymph Node Dissection with Immediate Lymphatic Reconstruction. J Reconstr Microsurg 2024. [PMID: 38866037 DOI: 10.1055/s-0044-1787727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND Lymphedema can occur in patients undergoing axillary lymph node dissection (ALND) and radiation for breast cancer. Immediate lymphatic reconstruction (ILR) is performed to decrease the risk of lymphedema in patients after ALND. Some patients who ultimately require ALND are candidates for attempted sentinel lymph node biopsy (SLNB) or targeted axillary excision. In those scenarios, ALND can be performed (1) immediately if frozen sections are positive or (2) as a second operation following permanent pathology. The purpose of this study is to evaluate immediate ALND/ILR following positive intraoperative frozen sections to guide surgical decision-making and operative planning. METHODS A single-center retrospective review was performed (2019-2022) for breast cancer patients undergoing axillary node surgery with breast reconstruction. Patients were divided into two groups: immediate conversion to ALND/ILR (Group 1) and no immediate conversion to ALND (Group 2). Demographic data and operative time were recorded. RESULTS There were 148 patients who underwent mastectomy, tissue expander (TE) reconstruction, and axillary node surgery. Group 1 included 30 patients who had mastectomy, sentinel node/targeted node biopsy, TE reconstruction, and intraoperative conversion to immediate ALND/ILR. Group 2 had 118 patients who underwent mastectomy with TE reconstruction and SLNB with no ALND or ILR. Operative time for bilateral surgery was 303.1 ± 63.2 minutes in Group 1 compared with 222.6 ± 52.2 minutes in Group 2 (p = 0.001). Operative time in Group 1 patients undergoing unilateral surgery was 252.3 ± 71.6 minutes compared with 171.3 ± 43.2 minutes in Group 2 (p = 0.001). CONCLUSION Intraoperative frozen section of sentinel/targeted nodes extended operative time by approximately 80 minutes in patients undergoing mastectomy with breast reconstruction and conversion of SLNB to ALND/ILR. Intraoperative conversion to ALND adds unpredictability to the operation as well as additional potentially unaccounted operative time. However, staging ALND requires an additional operation.
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Affiliation(s)
- Shahnur Ahmed
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Luci Hulsman
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dylan Roth
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carla Fisher
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kandice Ludwig
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Folasade O Imeokparia
- Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Mary E Lester
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aladdin H Hassanein
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Ma ZY, Zhang XF, Hu YZ, Zhu MD, Jin J, Qian P. Comparison of staining quality between rapid and routine hematoxylin and eosin staining of frozen breast tissue sections: an observational study. J Int Med Res 2024; 52:3000605241259682. [PMID: 38886869 PMCID: PMC11184997 DOI: 10.1177/03000605241259682] [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: 01/16/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE To compare the staining quality between rapid hematoxylin and eosin (H&E) staining and routine H&E staining of frozen breast tissue sections. METHODS In this cross-sectional observational study, 120 frozen breast tissue sections were randomly assigned to rapid or routine H&E staining (n = 60 per group). Rapid H&E staining used a 7:1 mixture of modified Gill's hematoxylin and alcohol-soluble 1% eosin Y. The staining quality of each section was evaluated and scored. A score of >7 was considered excellent, a score of 6 to 7 good, and a score of ≤5 poor. RESULTS The staining time for rapid staining was approximately 3 minutes, whereas that of routine staining was approximately 12 minutes. There were no significant differences in the staining quality scores or proportions of sections in each grade between the two staining methods. The proportions of sections that were classified as excellent or good were 96.7% and 98.3% for rapid and routine staining, respectively. CONCLUSIONS In frozen breast tissue sections, rapid H&E staining may provide staining quality that is comparable to that of routine staining, while markedly reducing the staining time.
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Affiliation(s)
- Zhen Yi Ma
- Department of Pathology and Clinical Laboratory, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, China
| | - Xiao Fang Zhang
- Department of Pathology and Clinical Laboratory, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, China
| | - Yan Ze Hu
- Department of Pathology and Clinical Laboratory, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, China
| | - Min Da Zhu
- Department of Pathology and Clinical Laboratory, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, China
| | - Jia Jin
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Ping Qian
- Department of Pathology and Clinical Laboratory, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, China
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Wang R, Ekem L, Gallagher J, Factor RE, Hall A, Ramanujam N. A color-based tumor segmentation method for clinical ex vivo breast tissue assessment utilizing a multi-contrast brightfield imaging strategy. JOURNAL OF BIOPHOTONICS 2024; 17:e202300241. [PMID: 38348582 PMCID: PMC11065618 DOI: 10.1002/jbio.202300241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 03/21/2024]
Abstract
We demonstrate an automated two-step tumor segmentation method leveraging color information from brightfield images of fresh core needle biopsies of breast tissue. Three different color spaces (HSV, CIELAB, YCbCr) were explored for the segmentation task. By leveraging white-light and green-light images, we identified two different types of color transformations that could separate adipose from benign and tumor or cancerous tissue. We leveraged these two distinct color transformation methods in a two-step process where adipose tissue segmentation was followed by benign tissue segmentation thereby isolating the malignant region of the biopsy. Our tumor segmentation algorithm and imaging probe could highlight suspicious regions on unprocessed biopsy tissue to guide selection of areas most similar to malignant tissues for tissue pathology whether it be formalin fixed or frozen sections, expedite tissue selection for molecular testing, detect positive tumor margins, or serve an alternative to tissue pathology, in countries where these services are lacking.
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Affiliation(s)
- Roujia Wang
- Department of Biomedical Engineering, Duke University, 27710 Durham, NC, USA
| | - Lillian Ekem
- Department of Biomedical Engineering, Duke University, 27710 Durham, NC, USA
| | - Jennifer Gallagher
- Department of Surgery, Duke University School of Medicine, 27710 Durham, NC, USA
| | | | - Allison Hall
- Department of Pathology, Duke University, 27710 Durham, NC, USA
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, 27710 Durham, NC, USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, 27710 Durham, NC, USA
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Veluponnar D, de Boer LL, Dashtbozorg B, Jong LJS, Geldof F, Guimaraes MDS, Sterenborg HJCM, Vrancken-Peeters MJTFD, van Duijnhoven F, Ruers T. Margin assessment during breast conserving surgery using diffuse reflectance spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:045006. [PMID: 38665316 PMCID: PMC11045169 DOI: 10.1117/1.jbo.29.4.045006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
Significance During breast-conserving surgeries, it is essential to evaluate the resection margins (edges of breast specimen) to determine whether the tumor has been removed completely. In current surgical practice, there are no methods available to aid in accurate real-time margin evaluation. Aim In this study, we investigated the diagnostic accuracy of diffuse reflectance spectroscopy (DRS) combined with tissue classification models in discriminating tumorous tissue from healthy tissue up to 2 mm in depth on the actual resection margin of in vivo breast tissue. Approach We collected an extensive dataset of DRS measurements on ex vivo breast tissue and in vivo breast tissue, which we used to develop different classification models for tissue classification. Next, these models were used in vivo to evaluate the performance of DRS for tissue discrimination during breast conserving surgery. We investigated which training strategy yielded optimum results for the classification model with the highest performance. Results We achieved a Matthews correlation coefficient of 0.76, a sensitivity of 96.7% (95% CI 95.6% to 98.2%), a specificity of 90.6% (95% CI 86.3% to 97.9%) and an area under the curve of 0.98 by training the optimum model on a combination of ex vivo and in vivo DRS data. Conclusions DRS allows real-time margin assessment with a high sensitivity and specificity during breast-conserving surgeries.
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Affiliation(s)
- Dinusha Veluponnar
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
- University of Twente, Department of Nanobiophysics, Faculty of Science and Technology, Enschede, The Netherlands
| | - Lisanne L. de Boer
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
| | - Behdad Dashtbozorg
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
| | - Lynn-Jade S. Jong
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
- University of Twente, Department of Nanobiophysics, Faculty of Science and Technology, Enschede, The Netherlands
| | - Freija Geldof
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
- University of Twente, Department of Nanobiophysics, Faculty of Science and Technology, Enschede, The Netherlands
| | - Marcos Da Silva Guimaraes
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Pathology, Amsterdam, The Netherlands
| | - Henricus J. C. M. Sterenborg
- Amsterdam University Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | | | - Frederieke van Duijnhoven
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
| | - Theo Ruers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgery, Image-Guided Surgery, Amsterdam, The Netherlands
- University of Twente, Department of Nanobiophysics, Faculty of Science and Technology, Enschede, The Netherlands
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8
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Torras I, Cebrecos I, Castillo H, Mension E. Evolution of breast conserving surgery-current implementation of oncoplastic techniques in breast conserving surgery: a literature review. Gland Surg 2024; 13:412-425. [PMID: 38601289 PMCID: PMC11002492 DOI: 10.21037/gs-23-454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/18/2024] [Indexed: 04/12/2024]
Abstract
Background and Objective De-escalation in breast cancer surgery has been a natural evolution since breast conserving surgery (BCS) was introduced in the early 1980s. From Halsted mastectomies to wide local excisions, we are facing nowadays the next trend in form of oncoplastic breast surgery. Oncoplastic breast surgery combines oncological principles with plastic surgery techniques to preserve the breast shape and appearance. The aim of this work is to review recent oncological and quality of live outcomes derived from oncoplastic techniques as well as offer a perspective about its implementation in breast cancer units. Methods A literature review was conducted to explore the landscape of oncoplastic breast surgery. Key terms related to oncoplastic techniques and breast cancer were used in searches across databases such as PubMed, Embase and Cochrane Library. Inclusion criteria focused on recent articles discussing oncological and quality of life (QoL) outcomes, as well as perspectives on the role of oncoplastic surgery. Key Content and Findings The research aims to contribute valuable insights into the efficacy and impact of oncoplastic surgery in the context of breast cancer treatment. In this new era of precision medicine, it is more than just healing patients; it is about improving their well-being. We ought to consider specific oncoplasty role in leading this paradigm shift. It is also relevant to define whether these new technical-demanding surgical options can be applied to all patients and if professional training performs adequately to current demands of personalized treatments. Conclusions The global adoption of oncoplastic BCS is recommended due to its oncological safety and improvement in QoL compared to standard procedures. Emphasizing the need for skilled surgeons in complex cases, collaboration between breast surgeons and scientific societies is urged to certify ongoing educational training in oncoplastic techniques.
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Affiliation(s)
| | | | - Helena Castillo
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Eduard Mension
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, Barcelona, Spain
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Garza KY, King ME, Nagi C, DeHoog RJ, Zhang J, Sans M, Krieger A, Feider CL, Bensussan AV, Keating MF, Lin JQ, Sun MW, Tibshirani R, Pirko C, Brahmbhatt KA, Al-Fartosi AR, Thompson AM, Bonefas E, Suliburk J, Carter SA, Eberlin LS. Intraoperative Evaluation of Breast Tissues During Breast Cancer Operations Using the MasSpec Pen. JAMA Netw Open 2024; 7:e242684. [PMID: 38517441 PMCID: PMC10960202 DOI: 10.1001/jamanetworkopen.2024.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/30/2023] [Indexed: 03/23/2024] Open
Abstract
Importance Surgery with complete tumor resection remains the main treatment option for patients with breast cancer. Yet, current technologies are limited in providing accurate assessment of breast tissue in vivo, warranting development of new technologies for surgical guidance. Objective To evaluate the performance of the MasSpec Pen for accurate intraoperative assessment of breast tissues and surgical margins based on metabolic and lipid information. Design, Setting, and Participants In this diagnostic study conducted between February 23, 2017, and August 19, 2021, the mass spectrometry-based device was used to analyze healthy breast and invasive ductal carcinoma (IDC) banked tissue samples from adult patients undergoing breast surgery for ductal carcinomas or nonmalignant conditions. Fresh-frozen tissue samples and touch imprints were analyzed in a laboratory. Intraoperative in vivo and ex vivo breast tissue analyses were performed by surgical staff in operating rooms (ORs) within 2 different hospitals at the Texas Medical Center. Molecular data were used to build statistical classifiers. Main Outcomes and Measures Prediction results of tissue analyses from classification models were compared with gross assessment, frozen section analysis, and/or final postoperative pathology to assess accuracy. Results All data acquired from the 143 banked tissue samples, including 79 healthy breast and 64 IDC tissues, were included in the statistical analysis. Data presented rich molecular profiles of healthy and IDC banked tissue samples, with significant changes in relative abundances observed for several metabolic species. Statistical classifiers yielded accuracies of 95.6%, 95.5%, and 90.6% for training, validation, and independent test sets, respectively. A total of 25 participants enrolled in the clinical, intraoperative study; all were female, and the median age was 58 years (IQR, 44-66 years). Intraoperative testing of the technology was successfully performed by surgical staff during 25 breast operations. Of 273 intraoperative analyses performed during 25 surgical cases, 147 analyses from 22 cases were subjected to statistical classification. Testing of the classifiers on 147 intraoperative mass spectra yielded 95.9% agreement with postoperative pathology results. Conclusions and Relevance The findings of this diagnostic study suggest that the mass spectrometry-based system could be clinically valuable to surgeons and patients by enabling fast molecular-based intraoperative assessment of in vivo and ex vivo breast tissue samples and surgical margins.
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Affiliation(s)
- Kyana Y. Garza
- Department of Chemistry, The University of Texas at Austin
| | - Mary E. King
- Department of Chemistry, The University of Texas at Austin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Chandandeep Nagi
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Rachel J. DeHoog
- Department of Chemistry, The University of Texas at Austin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jialing Zhang
- Department of Chemistry, The University of Texas at Austin
| | - Marta Sans
- Department of Chemistry, The University of Texas at Austin
| | - Anna Krieger
- Department of Chemistry, The University of Texas at Austin
| | | | | | - Michael F. Keating
- Department of Chemistry, The University of Texas at Austin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - John Q. Lin
- Department of Chemistry, The University of Texas at Austin
| | - Min Woo Sun
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Robert Tibshirani
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Christopher Pirko
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Kirtan A. Brahmbhatt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Ahmed R. Al-Fartosi
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Alastair M. Thompson
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Elizabeth Bonefas
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - James Suliburk
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Stacey A. Carter
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Livia S. Eberlin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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10
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Jong LJS, Appelman JGC, Sterenborg HJCM, Ruers TJM, Dashtbozorg B. Spatial and Spectral Reconstruction of Breast Lumpectomy Hyperspectral Images. SENSORS (BASEL, SWITZERLAND) 2024; 24:1567. [PMID: 38475103 DOI: 10.3390/s24051567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
(1) Background: Hyperspectral imaging has emerged as a promising margin assessment technique for breast-conserving surgery. However, to be implicated intraoperatively, it should be both fast and capable of yielding high-quality images to provide accurate guidance and decision-making throughout the surgery. As there exists a trade-off between image quality and data acquisition time, higher resolution images come at the cost of longer acquisition times and vice versa. (2) Methods: Therefore, in this study, we introduce a deep learning spatial-spectral reconstruction framework to obtain a high-resolution hyperspectral image from a low-resolution hyperspectral image combined with a high-resolution RGB image as input. (3) Results: Using the framework, we demonstrate the ability to perform a fast data acquisition during surgery while maintaining a high image quality, even in complex scenarios where challenges arise, such as blur due to motion artifacts, dead pixels on the camera sensor, noise from the sensor's reduced sensitivity at spectral extremities, and specular reflections caused by smooth surface areas of the tissue. (4) Conclusion: This gives the opportunity to facilitate an accurate margin assessment through intraoperative hyperspectral imaging.
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Affiliation(s)
- Lynn-Jade S Jong
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Jelmer G C Appelman
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1111, 1081 HV Amsterdam, The Netherlands
| | - Henricus J C M Sterenborg
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Theo J M Ruers
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Byrd BK, Wells WA, Strawbridge RR, Barth CW, Samkoe KS, Gibbs SL, Davis SC. Evaluating Receptor-Specific Fresh Specimen Staining for Tumor Margin Detection in Clinical Breast Specimens. Mol Imaging Biol 2023; 25:911-922. [PMID: 37351769 PMCID: PMC10598096 DOI: 10.1007/s11307-022-01771-9] [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: 07/01/2022] [Revised: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 06/24/2023]
Abstract
PURPOSE Reliable and rapid identification of tumor in the margins of breast specimens during breast-conserving surgery to reduce repeat surgery rates is an active area of investigation. Dual-stain difference imaging (DDSI) is one of many approaches under evaluation for this application. This technique aims to topically apply fluorescent stain pairs (one targeted to a receptor-of-interest and the other a spectrally distinct isotype), image both stains, and compute a normalized difference image between the two channels. Prior evaluation and optimization in a variety of preclinical models produced encouraging diagnostic performance. Herein, we report on a pilot clinical study which evaluated HER2-targeted DDSI on 11 human breast specimens. PROCEDURES Gross sections from 11 freshly excised mastectomy specimens were processed using a HER2-receptor-targeted DDSI protocol shortly after resection. After staining with the dual-probe protocol, specimens were imaged on a fluorescence scanner, followed by tissue fixation for hematoxylin and eosin and anti-HER2 immunohistochemical staining. Receiver operator characteristic curves and area under the curve (AUC) analysis were used to assess diagnostic performance of the resulting images. Performance values were also compared to expression level determined from IHC staining. RESULTS Eight of the 11 specimens presented with distinguishable invasive ductal carcinoma and/or were not affected by an imaging artifact. In these specimens, the DDSI technique provided an AUC = 0.90 ± 0.07 for tumor-to-adipose tissue and 0.81 ± 0.15 for tumor-to-glandular tissue, which was significantly higher than AUC values recovered from images of the targeted probe alone. DDSI values and diagnostic performance did not correlate with HER2 expression level, and tumors with low HER2 expression often produced high AUC, suggesting that even the low expression levels were enough to help distinguish tumor. CONCLUSIONS The results from this preliminary study of rapid receptor-specific staining in human specimens were consistent with prior preclinical results and demonstrated promising diagnostic potential.
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Affiliation(s)
- Brook K Byrd
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Wendy A Wells
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | | | - Connor W Barth
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, 97201, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR, 97201, USA
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.
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12
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Haskell J, Hubbard T, Murray C, Gardner B, Ives C, Ferguson D, Stone N. High wavenumber Raman spectroscopy for intraoperative assessment of breast tumour margins. Analyst 2023; 148:4373-4385. [PMID: 37594446 DOI: 10.1039/d3an00574g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Optimal oncological results and patient outcomes are achieved in surgery for early breast cancer with breast conserving surgery (BCS) where this is appropriate. A limitation of BCS occurs when cancer is present at, or close, to the resection margin - termed a 'positive' margin - and re-excision is recommended to reduce recurrence rate. This is occurs in 17% of BCS in the UK and there is therefore a critical need for a way to assess margin status intraoperatively to ensure complete excision with adequate margins at the first operation. This study presents the potential of high wavenumber (HWN) Raman spectroscopy to address this. Freshly excised specimens from thirty patients undergoing surgery for breast cancer were measured using a surface Raman probe, and a multivariate classification model to predict normal versus tumour was developed from the data. This model achieved 77.1% sensitivity and 90.8% specificity following leave one patient out cross validation, with the defining features being differences in water content and lipid versus protein content. This demonstrates the feasibility of HWN Raman spectroscopy to facilitate future intraoperative margin assessment at specific locations. Clinical utility of the approach will require further research.
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Affiliation(s)
- Jennifer Haskell
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Thomas Hubbard
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Claire Murray
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Benjamin Gardner
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Charlotte Ives
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Douglas Ferguson
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Nick Stone
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
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13
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Jong LJS, Post AL, Veluponnar D, Geldof F, Sterenborg HJCM, Ruers TJM, Dashtbozorg B. Tissue Classification of Breast Cancer by Hyperspectral Unmixing. Cancers (Basel) 2023; 15:2679. [PMID: 37345015 DOI: 10.3390/cancers15102679] [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: 04/04/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023] Open
Abstract
(1) Background: Assessing the resection margins during breast-conserving surgery is an important clinical need to minimize the risk of recurrent breast cancer. However, currently there is no technique that can provide real-time feedback to aid surgeons in the margin assessment. Hyperspectral imaging has the potential to overcome this problem. To classify resection margins with this technique, a tissue discrimination model should be developed, which requires a dataset with accurate ground-truth labels. However, establishing such a dataset for resection specimens is difficult. (2) Methods: In this study, we therefore propose a novel approach based on hyperspectral unmixing to determine which pixels within hyperspectral images should be assigned to the ground-truth labels from histopathology. Subsequently, we use this hyperspectral-unmixing-based approach to develop a tissue discrimination model on the presence of tumor tissue within the resection margins of ex vivo breast lumpectomy specimens. (3) Results: In total, 372 measured locations were included on the lumpectomy resection surface of 189 patients. We achieved a sensitivity of 0.94, specificity of 0.85, accuracy of 0.87, Matthew's correlation coefficient of 0.71, and area under the curve of 0.92. (4) Conclusion: Using this hyperspectral-unmixing-based approach, we demonstrated that the measured locations with hyperspectral imaging on the resection surface of lumpectomy specimens could be classified with excellent performance.
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Affiliation(s)
- Lynn-Jade S Jong
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Anouk L Post
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Dinusha Veluponnar
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Freija Geldof
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Henricus J C M Sterenborg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Theo J M Ruers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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14
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Gubarkova E, Kiseleva E, Moiseev A, Vorontsov D, Kuznetsov S, Plekhanov A, Karabut M, Sirotkina M, Gelikonov G, Gamayunov S, Vorontsov A, Krivorotko P, Gladkova N. Intraoperative Assessment of Breast Cancer Tissues after Breast-Conserving Surgery Based on Mapping the Attenuation Coefficients in 3D Cross-Polarization Optical Coherence Tomography. Cancers (Basel) 2023; 15:cancers15092663. [PMID: 37174128 PMCID: PMC10177188 DOI: 10.3390/cancers15092663] [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: 03/15/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
Intraoperative differentiation of tumorous from non-tumorous tissue can help in the assessment of resection margins in breast cancer and its response to therapy and, potentially, reduce the incidence of tumor recurrence. In this study, the calculation of the attenuation coefficient and its color-coded 2D distribution was performed for different breast cancer subtypes using spectral-domain CP OCT. A total of 68 freshly excised human breast specimens containing tumorous and surrounding non-tumorous tissues after BCS was studied. Immediately after obtaining structural 3D CP OCT images, en face color-coded attenuation coefficient maps were built in co-(Att(co)) and cross-(Att(cross)) polarization channels using a depth-resolved approach to calculating the values in each A-scan. We determined spatially localized signal attenuation in both channels and reported ranges of attenuation coefficients to five selected breast tissue regions (adipose tissue, non-tumorous fibrous connective tissue, hyalinized tumor stroma, low-density tumor cells in the fibrotic tumor stroma and high-density clusters of tumor cells). The Att(cross) coefficient exhibited a stronger gain contrast of studied tissues compared to the Att(co) coefficient (i.e., conventional attenuation coefficient) and, therefore, allowed improved differentiation of all breast tissue types. It has been shown that color-coded attenuation coefficient maps may be used to detect inter- and intra-tumor heterogeneity of various breast cancer subtypes as well as to assess the effectiveness of therapy. For the first time, the optimal threshold values of the attenuation coefficients to differentiate tumorous from non-tumorous breast tissues were determined. Diagnostic testing values for Att(cross) coefficient were higher for differentiation of tumor cell areas and tumor stroma from non-tumorous fibrous connective tissue: diagnostic accuracy was 91-99%, sensitivity-96-98%, and specificity-87-99%. Att(co) coefficient is more suitable for the differentiation of tumor cell areas from adipose tissue: diagnostic accuracy was 83%, sensitivity-84%, and specificity-84%. Therefore, the present study provides a new diagnostic approach to the differentiation of breast cancer tissue types based on the assessment of the attenuation coefficient from real-time CP OCT data and has the potential to be used for further rapid and accurate intraoperative assessment of the resection margins during BCS.
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Affiliation(s)
- Ekaterina Gubarkova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia
| | - Elena Kiseleva
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia
| | - Alexander Moiseev
- Institute of Applied Physics of the Russian Academy of Sciences, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia
| | - Dmitry Vorontsov
- Nizhny Novgorod Regional Oncologic Hospital, 11/1 Delovaya St., 603126 Nizhny Novgorod, Russia
| | - Sergey Kuznetsov
- Nizhny Novgorod Regional Oncologic Hospital, 11/1 Delovaya St., 603126 Nizhny Novgorod, Russia
| | - Anton Plekhanov
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia
| | - Maria Karabut
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia
| | - Marina Sirotkina
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia
| | - Grigory Gelikonov
- Institute of Applied Physics of the Russian Academy of Sciences, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia
| | - Sergey Gamayunov
- Nizhny Novgorod Regional Oncologic Hospital, 11/1 Delovaya St., 603126 Nizhny Novgorod, Russia
| | - Alexey Vorontsov
- Nizhny Novgorod Regional Oncologic Hospital, 11/1 Delovaya St., 603126 Nizhny Novgorod, Russia
| | - Petr Krivorotko
- N.N. Petrov National Medicine Research Center of Oncology, 68 Leningradskaya St., 197758 St. Petersburg, Russia
| | - Natalia Gladkova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia
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15
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Scholler J, Mandache D, Mathieu MC, Lakhdar AB, Darche M, Monfort T, Boccara C, Olivo-Marin JC, Grieve K, Meas-Yedid V, la Guillaume EBA, Thouvenin O. Automatic diagnosis and classification of breast surgical samples with dynamic full-field OCT and machine learning. J Med Imaging (Bellingham) 2023; 10:034504. [PMID: 37274760 PMCID: PMC10234284 DOI: 10.1117/1.jmi.10.3.034504] [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: 02/03/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose The adoption of emerging imaging technologies in the medical community is often hampered when they provide a new unfamiliar contrast that requires experience to be interpreted. Dynamic full-field optical coherence tomography (D-FF-OCT) microscopy is such an emerging technique. It provides fast, high-resolution images of excised tissues with a contrast comparable to H&E histology but without any tissue preparation and alteration. Approach We designed and compared two machine learning approaches to support interpretation of D-FF-OCT images of breast surgical specimens and thus provide tools to facilitate medical adoption. We conducted a pilot study on 51 breast lumpectomy and mastectomy surgical specimens and more than 1000 individual 1.3 × 1.3 mm 2 images and compared with standard H&E histology diagnosis. Results Using our automatic diagnosis algorithms, we obtained an accuracy above 88% at the image level (1.3 × 1.3 mm 2 ) and above 96% at the specimen level (above cm 2 ). Conclusions Altogether, these results demonstrate the high potential of D-FF-OCT coupled to machine learning to provide a rapid, automatic, and accurate histopathology diagnosis with minimal sample alteration.
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Affiliation(s)
- Jules Scholler
- PSL University, Institut Langevin, ESPCI Paris, CNRS, Paris, France
| | - Diana Mandache
- AQUYRE Bioscences-LLTech SAS, Paris, France
- Institut Pasteur, Bioimage Analysis Unit, Paris, France
| | - Marie Christine Mathieu
- Gustave Roussy Cancer Campus, Department of Medical Biology and Pathology, Villejuif, France
| | | | - Marie Darche
- Sorbonne Université, Institut de la Vision, INSERM, CNRS, Paris, France
| | - Tual Monfort
- PSL University, Institut Langevin, ESPCI Paris, CNRS, Paris, France
| | - Claude Boccara
- PSL University, Institut Langevin, ESPCI Paris, CNRS, Paris, France
| | | | - Kate Grieve
- Sorbonne Université, Institut de la Vision, INSERM, CNRS, Paris, France
- Quinze-Vingts National Eye Hospital, Paris, France
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16
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Aref MH, El-Gohary M, Elrewainy A, Mahmoud A, Aboughaleb IH, Hussein AA, El-Ghaffar SA, Mahran A, El-Sharkawy YH. Emerging Technology for Intraoperative Margin and Assisting in Post-Surgery tissue diagnostic for Future Breast-Conserving. Photodiagnosis Photodyn Ther 2023; 42:103507. [PMID: 36940788 DOI: 10.1016/j.pdpdt.2023.103507] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/13/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Tissue-preserving surgery is utilized progressively in cancer therapy, where a clear surgical margin is critical to avoid cancer recurrence, specifically in breast cancer (BC) surgery. The Intraoperative pathologic approaches that rely on tissue segmenting and staining have been recognized as the ground truth for BC diagnosis. Nevertheless, these methods are constrained by its complication and timewasting for tissue preparation. OBJECTIVE We present a non-invasive optical imaging system incorporating a hyperspectral (HS) camera to discriminate between cancerous and non-cancerous tissues in ex-vivo breast specimens, which could be an intraoperative diagnostic technique to aid surgeons during surgery and later a valuable tool to assist pathologists. METHODS We have established a hyperspectral Imaging (HSI) system comprising a push-broom HS camera at wavelength 380∼1050 nm with source light 390∼980 nm. We have measured the investigated samples' diffuse reflectance (Rd), fixed on slides from 30 distinct patients incorporating mutually normal and ductal carcinoma tissue. The samples were divided into two groups, stained tissues during the surgery (control group) and unstained samples (test group), both captured with the HSI system in the visible and near-infrared (VIS-NIR) range. Then, to address the problem of the spectral nonuniformity of the illumination device and the influence of the dark current, the radiance data were normalized to yield the radiance of the specimen and neutralize the intensity effect to focus on the spectral reflectance shift for each tissue. The selection of the threshold window from the measured Rd is carried out by exploiting the statistical analysis by calculating each region's mean and standard deviation. Afterward, we selected the optimum spectral images from the HS data cube to apply a custom K-means algorithm and contour delineation to identify the regular districts from the BC regions. RESULTS We noticed that the measured spectral Rd for the malignant tissues of the investigated case studies versus the reference source light varies regarding the cancer stage, as sometimes the Rd is higher for the tumor or vice versa for the normal tissue. Later, from the analysis of the whole samples, we found that the most appropriate wavelength for the BC tissues was 447 nm, which was highly reflected versus the normal tissue. However, the most convenient one for the normal tissue was at 545 nm with high reflection versus the BC tissue. Finally, we implement a moving average filter for noise reduction and a custom K-means clustering algorithm on the selected two spectral images (447, 551 nm) to identify the various regions and effectively-identified spectral tissue variations with a sensitivity of 98.95%, and specificity of 98.44%. A pathologist later confirmed these outcomes as the ground truth for the tissue sample investigations. CONCLUSIONS The proposed system could help the surgeon and the pathologist identify the cancerous tissue margins from the non-cancerous tissue with a non-invasive, rapid, and minimum time method achieving high sensitivity up to 98.95%.
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Affiliation(s)
| | - Mohamed El-Gohary
- Demonstrator, Communications Department, Faculty of Engineering, Mansoura University, Mansoura, Egypt.
| | - Ahmed Elrewainy
- Avionics Department, Electrical Engineering Branch, Military Technical College, Cairo, Egypt.
| | - Alaaeldin Mahmoud
- Optoelectronics and advanced control systems Department, Military Technical College, Cairo, Egypt.
| | | | | | | | - Ashraf Mahran
- Avionics Department, Military Technical College, Cairo, Egypt.
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17
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Veluponnar D, de Boer LL, Geldof F, Jong LJS, Da Silva Guimaraes M, Vrancken Peeters MJTFD, van Duijnhoven F, Ruers T, Dashtbozorg B. Toward Intraoperative Margin Assessment Using a Deep Learning-Based Approach for Automatic Tumor Segmentation in Breast Lumpectomy Ultrasound Images. Cancers (Basel) 2023; 15:cancers15061652. [PMID: 36980539 PMCID: PMC10046373 DOI: 10.3390/cancers15061652] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
There is an unmet clinical need for an accurate, rapid and reliable tool for margin assessment during breast-conserving surgeries. Ultrasound offers the potential for a rapid, reproducible, and non-invasive method to assess margins. However, it is challenged by certain drawbacks, including a low signal-to-noise ratio, artifacts, and the need for experience with the acquirement and interpretation of images. A possible solution might be computer-aided ultrasound evaluation. In this study, we have developed new ensemble approaches for automated breast tumor segmentation. The ensemble approaches to predict positive and close margins (distance from tumor to margin ≤ 2.0 mm) in the ultrasound images were based on 8 pre-trained deep neural networks. The best optimum ensemble approach for segmentation attained a median Dice score of 0.88 on our data set. Furthermore, utilizing the segmentation results we were able to achieve a sensitivity of 96% and a specificity of 76% for predicting a close margin when compared to histology results. The promising results demonstrate the capability of AI-based ultrasound imaging as an intraoperative surgical margin assessment tool during breast-conserving surgery.
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Affiliation(s)
- Dinusha Veluponnar
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Lisanne L de Boer
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Freija Geldof
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Lynn-Jade S Jong
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marcos Da Silva Guimaraes
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - Frederieke van Duijnhoven
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Theo Ruers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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18
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Abdelsattar JM, Afridi FG, Dai Z, Yousaf N, Seldomridge A, Battin AO, Wen S, Gray D, Marsh JW, Cowher MS, Partin JF, Hazard-Jenkins H, Lupinacci K. The Effect of Lumpectomy and Cavity Shave Margin Status on Recurrence and Survival in Breast-Conserving Surgery. Am Surg 2023; 89:424-433. [PMID: 34196595 DOI: 10.1177/00031348211030464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVE Cavity shave margins (CSMs) decrease rate of positive margins and need for re-excision. Recurrence data following breast-conserving surgery (BCS) are not always available in large cancer registries. We sought to define our recurrence and survival data in BCS with routine excision of CSMs. METHODS A single institution, 10-year retrospective review of breast cancer patients who underwent BCS with routine CSMs was conducted. Cavity shave margin technique was standard. Cox proportional hazard analyses and the Kaplan-Meier method were used to estimate recurrence and survival. RESULTS Breast-conserving surgery with CSM was performed in 839 patients. Re-excision rate to achieve negative margins was 8.5%. Fifty-two patients (75%) underwent margin re-excision vs 18 patients (25%) underwent salvage mastectomy. Positive margin rate stratified by tumor histology was highest for invasive lobular carcinoma followed by mixed invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS), followed by pure DCIS and lowest for IDC. Length of follow-up was (4.7 ± 2.6, years). Overall recurrence rate (locoregional and systemic) was 4.3%: highest in patients with negative lumpectomy margin but positive CSM (L-S+ = 15%) followed by positive lumpectomy and CSMs (L+S+ = 14%), followed by patients with positive lumpectomy margin but negative CSMs (L+S- = 13%) and lowest for negative lumpectomy and CSM (L-S- = 5%), (P = .0008). There was no difference in 5-year breast cancer-specific survival between the 4 subgroups: 96% for L-S-, 86.7% L-S+, 94.7% L+S+ and 90% L+S- (P = .094). CONCLUSIONS Recurrence following BCS with CSMs can be stratified based on both lumpectomy and cavity shave margin positivity. Routine excision of CSMs allows identification of these patient subsets.
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Affiliation(s)
- Jad M Abdelsattar
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Faryal G Afridi
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Zheng Dai
- Department of Epidemiology, 53422West Virginia University, Morgantown, WV, USA
| | - Natasha Yousaf
- School of Medicine, 53422West Virginia University, Morgantown, WV, USA
| | | | | | - Sijin Wen
- Department of Biostatistics, 53422West Virginia University, Morgantown, WV, USA
| | - Dana Gray
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - J Wallis Marsh
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | - Michael S Cowher
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
| | | | | | - Kristin Lupinacci
- Department of Surgery, 53422West Virginia University, Morgantown, WV, USA
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19
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Optical spectroscopy and chemometrics in intraoperative tumor margin assessment. Trends Analyt Chem 2023. [DOI: 10.1016/j.trac.2023.116955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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20
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Rascevska E, Yip L, Omidi P, Brackstone M, Carson J. Investigating the feasibility of a hand-held photoacoustic imaging probe for margin assessment during breast conserving surgery. PHOTOACOUSTICS 2022; 28:100424. [PMID: 36386296 PMCID: PMC9650058 DOI: 10.1016/j.pacs.2022.100424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Approximately 19 % of breast cancer patients undergoing breast conserving surgery (BCS) must return for a secondary surgery due to incomplete tumour removal. Our previous work demonstrated that the lower lipid content, characteristic of tumour tissue, was observed as regions of hypo-intense photoacoustic (PA) contrast. The goal of this work was to evaluate feasibility of a low-frequency, hand-held PA imaging probe for surgical margin assessment based on lipid content differences. Here, we describe (i) the design of a prototype hand-held PA imaging probe, (ii) the effect of limited-bandwidth on image contrast, (iii) accuracy towards hypo-intense contrast detection, (iv) the limited-view characteristics of the single sensor design, and (iv) early imaging results of an ex-vivo breast cancer specimen. The probe incorporates a single polyvinylidene fluoride acoustic sensor, a 1-to-4 optical fibre bundle and a polycarbonate axicon lens for light delivery. Imaging results on phantoms designed to mimic positive margins demonstrated the ability to detect gaps in optical absorption as small as 1 mm in width. Compared to images from a near full-view PAI system, the hand-held PAI probe had higher signal to noise ratio but suffered from negativity image artifacts. Lumpectomy specimen imaging showed that strong signals can be obtained from the fatty tissue. Taken together, the results show this imaging approach with a hand-held probe has potential for detection of residual breast cancer tissue during BCS; however, more work is needed to reduce the size of the probe to fit within the surgical cavity.
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Affiliation(s)
- E. Rascevska
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor St., London N6A 4V2, ON, Canada
- School of Biomedical Engineering, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
| | - L.C.M. Yip
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor St., London N6A 4V2, ON, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
| | - P. Omidi
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor St., London N6A 4V2, ON, Canada
- School of Biomedical Engineering, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
| | - M. Brackstone
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
- Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond St., N6A 3K7, London, ON, Canada
| | - J.J.L. Carson
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor St., London N6A 4V2, ON, Canada
- School of Biomedical Engineering, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
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21
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Specimen mammography for intraoperative margin assessment in breast conserving surgery: a meta-analysis. Sci Rep 2022; 12:18440. [PMID: 36323863 PMCID: PMC9630505 DOI: 10.1038/s41598-022-23234-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/27/2022] [Indexed: 01/06/2023] Open
Abstract
In breast conserving surgery (BCS), specimen mammography is one of the most widely used intraoperative methods of assessing margin status. We performed a meta-analysis to evaluate the diagnostic accuracy of specimen mammography. Literature databases including PubMed, Cochrane Library, Web of Science, and EMBASE were searched prior to Jun 2022. A total of 1967 patients were included from 20 studies. A pooled analysis, heterogeneity testing, threshold effect testing, publication bias analysis, and subgroup analyses were performed from extracted data. The pooled weighted values were a sensitivity of 0.55 (95% confidence interval [CI], 0.47-0.63), a specificity of 0.85 (95% CI, 0.78-0.90), a diagnostic odds ratio of 7 (95% CI, 4-12), and a pooled positive likelihood ratio of 3.7 (95% CI 2.6-5.5). The area under the receiver operator characteristic curve was 0.75 (95% CI 0.71-0.78). In the subgroup analysis, the pooled specificity in the positive margin defined as tumor at margin subgroup was lower than the other positive margin definition subgroup (0.82 [95% CI: 0.71, 0.92] vs. 0.87 [95% CI: 0.80, 0.94], p = 0.01). Our findings indicated that specimen mammography was an accurate intraoperative imaging technique for margin assessment in BCS.
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22
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Gong P, Chin SL, Allen WM, Ballal H, Anstie JD, Chin L, Ismail HM, Zilkens R, Lakhiani DD, McCarthy M, Fang Q, Firth D, Newman K, Thomas C, Li J, Sanderson RW, Foo KY, Yeomans C, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Quantitative Micro-Elastography Enables In Vivo Detection of Residual Cancer in the Surgical Cavity during Breast-Conserving Surgery. Cancer Res 2022; 82:4093-4104. [PMID: 36098983 PMCID: PMC9627129 DOI: 10.1158/0008-5472.can-22-0578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/29/2022] [Accepted: 09/08/2022] [Indexed: 01/07/2023]
Abstract
Breast-conserving surgery (BCS) is commonly used for the treatment of early-stage breast cancer. Following BCS, approximately 20% to 30% of patients require reexcision because postoperative histopathology identifies cancer in the surgical margins of the excised specimen. Quantitative micro-elastography (QME) is an imaging technique that maps microscale tissue stiffness and has demonstrated a high diagnostic accuracy (96%) in detecting cancer in specimens excised during surgery. However, current QME methods, in common with most proposed intraoperative solutions, cannot image cancer directly in the patient, making their translation to clinical use challenging. In this proof-of-concept study, we aimed to determine whether a handheld QME probe, designed to interrogate the surgical cavity, can detect residual cancer directly in the breast cavity in vivo during BCS. In a first-in-human study, 21 BCS patients were scanned in vivo with the QME probe by five surgeons. For validation, protocols were developed to coregister in vivo QME with postoperative histopathology of the resected tissue to assess the capability of QME to identify residual cancer. In four cavity aspects presenting cancer and 21 cavity aspects presenting benign tissue, QME detected elevated stiffness in all four cancer cases, in contrast to low stiffness observed in 19 of the 21 benign cases. The results indicate that in vivo QME can identify residual cancer by directly imaging the surgical cavity, potentially providing a reliable intraoperative solution that can enable more complete cancer excision during BCS. SIGNIFICANCE Optical imaging of microscale tissue stiffness enables the detection of residual breast cancer directly in the surgical cavity during breast-conserving surgery, which could potentially contribute to more complete cancer excision.
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Affiliation(s)
- Peijun Gong
- 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 and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia.,Corresponding Author: Peijun Gong, BRITElab, Harry Perkins Institute of Medical Research, Perth 6009, Australia. Phone: 61-8-6488-6774; E-mail:
| | - Synn Lynn Chin
- Breast Centre, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - 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 and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Helen Ballal
- Breast Centre, Fiona Stanley Hospital, Murdoch, Western Australia, 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, Australia.,Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, 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, Perth, Western Australia, Australia.,Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Hina M. Ismail
- 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 and Computer Engineering, School of Engineering, The University of Western Australia, Perth, 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, Perth, Western Australia, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, 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, Perth, Western Australia, Australia.,Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, 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, Perth, Western Australia, Australia.,Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel Firth
- 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 and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Kyle Newman
- 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 and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Caleb Thomas
- 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 and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Jiayue Li
- 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 and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia.,Australian Research Council Centre for Personalised Therapeutics Technologies, Melbourne, Victoria, 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, Perth, Western Australia, Australia.,Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, 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, Perth, Western Australia, Australia.,Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Chris Yeomans
- PathWest, Fiona Stanley Hospital, Murdoch, 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.,The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Christobel M. Saunders
- Breast Centre, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Division of Surgery, Medical School, The University of Western Australia, Perth, 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 and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia.,Australian Research Council Centre for Personalised Therapeutics Technologies, Melbourne, Victoria, Australia
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23
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Schumacher JR, Lawson EH, Kong AL, Weber JJ, May J, Landercasper J, Hanlon B, Marka N, Venkatesh M, Cartmill RS, Pavuluri Quamme S, Nikolay C, Greenberg CC. A Statewide Approach to Reducing Re-excision Rates for Women With Breast-conserving Surgery. Ann Surg 2022; 276:665-672. [PMID: 35837946 PMCID: PMC9529150 DOI: 10.1097/sla.0000000000005590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Test the effectiveness of benchmarked performance reports based on existing discharge data paired with a statewide intervention to implement evidence-based strategies on breast re-excision rates. BACKGROUND Breast-conserving surgery (BCS) is a common breast cancer surgery performed in a range of hospital settings. Studies have demonstrated variations in post-BCS re-excision rates, identifying it as a high-value improvement target. METHODS Wisconsin Hospital Association discharge data (2017-2019) were used to compare 60-day re-excision rates following BCS for breast cancer. The analysis estimated the difference in the average change preintervention to postintervention between Surgical Collaborative of Wisconsin (SCW) and nonparticipating hospitals using a logistic mixed-effects model with repeated measures, adjusting for age, payer, and hospital volume, including hospitals as random effects. The intervention included 5 collaborative meetings in 2018 to 2019 where surgeon champions shared guideline updates, best practices/challenges, and facilitated action planning. Confidential benchmarked performance reports were provided. RESULTS In 2017, there were 3692 breast procedures in SCW and 1279 in nonparticipating hospitals; hospital-level re-excision rates ranged from 5% to >50%. There was no statistically significant baseline difference in re-excision rates between SCW and nonparticipating hospitals (16.1% vs. 17.1%, P =0.47). Re-excision significantly decreased for SCW but not for nonparticipating hospitals (odds ratio=0.69, 95% confidence interval=0.52-0.91). CONCLUSIONS Benchmarked performance reports and collaborative quality improvement can decrease post-BCS re-excisions, increase quality, and decrease costs. Our study demonstrates the effective use of administrative data as a platform for statewide quality collaboratives. Using existing data requires fewer resources and offers a new paradigm that promotes participation across practice settings.
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Affiliation(s)
| | - Elise H Lawson
- Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | - Amanda L Kong
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jeanette May
- Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | | | - Bret Hanlon
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI
| | - Nicholas Marka
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Manasa Venkatesh
- Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | - Randi S Cartmill
- Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | | | - Connor Nikolay
- Department of Surgery, University of Wisconsin-Madison, Madison, WI
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24
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The Importance of the Pathological Perspective in the Management of the Invasive Lobular Carcinoma. Breast J 2022; 2022:2461242. [PMID: 36237576 PMCID: PMC9529524 DOI: 10.1155/2022/2461242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022]
Abstract
Background Invasive lobular carcinomas (ILC) account for 10–15% of all breast cancers and are the second most common histological form of breast cancer. They usually show a discohesive pattern of single cell infiltration, tend to be multifocal, and the tumor may not be accompanied by a stromal reaction. Because of these histological features, which are not common in other breast tumors, radiological detection of the tumor may be difficult, and its pathological evaluation in terms of size and spread is often problematic. The SSO-ASTRO guideline defines the negative surgical margin in breast-conserving surgeries as the absence of tumor detection on the ink. However, surgical margin assessment in invasive lobular carcinomas has not been much discussed from the pathological perspective. Methods The study included 79 cases diagnosed with invasive lobular carcinoma by a Tru-cut biopsy where operated in our center between 2014 and 2021. Clinicopathological characteristics of the cases, results of an intraoperative frozen evaluation in cases that underwent conservative surgery, the necessity of re-excision and complementary mastectomy, and consistency in radiological and pathological response evaluation in cases receiving neoadjuvant treatment were questioned. Results The tumor was multifocal in 37 (46.8%) cases and single tumor focus in 42 (53.2%) cases. When the entire patient population was evaluated, regardless of focality, mastectomy was performed in 27 patients (34.2%) and breast-conserving surgery (BCS) was performed in 52 patients (65.8%). Of the 52 patients who underwent BCS, 26 (50%) required an additional surgical procedure (cavity revision or completion mastectomy). There is a statistical relationship between tumor size and additional surgical intervention (p < 0.05). BCS was performed in 7 of 12 patients who were operated on after neoadjuvant treatment, but all of them were reoperated with the same or a second session and turned to mastectomy. Neoadjuvant treatment and the need for reoperation were statistically significant (p < 0.05). Additional surgical procedures were performed in 20 (44.4%) of 45 patients in BCS cases who did not receive neoadjuvant therapy. Conclusions Diagnostic difficulties in the intraoperative frozen evaluation of invasive lobular carcinoma are due to the different histopathological patterns of the ILC. In our study, it was determined that large tumor size and neoadjuvant therapy increased the need for additional surgical procedures. It is thought that the pathological perspective is the determining factor in order to minimize the negative effects such as unsuccessful cosmesis, an additional surgical burden on the patient, and cost increase that may occur with additional surgical procedures; for this reason, new approaches should be discussed in the treatment planning of invasive lobular carcinoma cases.
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25
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Hwang ES, Beitsch P, Blumencranz P, Carr D, Chagpar A, Clark L, Dekhne N, Dodge D, Dyess DL, Gold L, Grobmyer S, Hunt K, Karp S, Lesnikoski BA, Wapnir I, Smith BL. Clinical Impact of Intraoperative Margin Assessment in Breast-Conserving Surgery With a Novel Pegulicianine Fluorescence-Guided System: A Nonrandomized Controlled Trial. JAMA Surg 2022; 157:573-580. [PMID: 35544130 PMCID: PMC9096689 DOI: 10.1001/jamasurg.2022.1075] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Importance Positive margins following breast-conserving surgery (BCS) are often identified on standard pathology evaluation. Intraoperative assessment of the lumpectomy cavity has the potential to reduce residual disease or reexcision rate following standard of care BCS in real time. Objective To collect safety and initial efficacy data on the novel pegulicianine fluorescence-guided system (pFGS) when used to identify residual cancer in the tumor bed of female patients undergoing BCS. Design, Setting, and Participants This prospective single-arm open-label study was conducted as a nonrandomized multicenter controlled trial at 16 academic or community breast centers across the US. Female patients 18 years and older with newly diagnosed primary invasive breast cancer or ductal carcinoma in situ DCIS undergoing BCS were included, excluding those with previous breast cancer surgery and a history of dye allergies. Of 283 consecutive eligible patients recruited, 234 received a pegulicianine injection and were included in the safety analysis; of these, 230 were included in the efficacy analysis. Patients were enrolled between February 6, 2018, and April 10, 2020, and monitored for a 30-day follow-up period. Data were analyzed from April 10, 2020, to August 5, 2021. Interventions Participants received an injection of a novel imaging agent (pegulicianine) a mean (SD) of 3.2 (0.9) hours prior to surgery at a dose of 1 mg/kg. After completing standard of care (SOC) excision, pFGS was used to scan the lumpectomy cavity to guide the removal of additional shave margins. Main Outcomes and Measures Adverse events and sensitivity, specificity, and reexcision rate. Results Of 234 female patients enrolled (median [IQR] age, 62.0 [55.0-69.0] years), 230 completed the trial and 1 patient with a history of allergy to contrast agents had an anaphylactic reaction and recovered without sequelae. Correlation of pFGS with final margin status on a per-margin analysis showed a marked improvement in sensitivity over standard pathology assessment of the main lumpectomy specimen (69.4% vs 38.2%, respectively). On a per-patient level, the false-negative rate of pFGS was 23.7% (9 of 38), and sensitivity was 76.3% (29 of 38). Among 32 patients who underwent excision of pFGS-guided shaves, pFGS averted the need for reexcision in 6 (19%). Conclusions and Relevance In this pilot feasibility study, the safety profile of pegulicianine was consistent with other imaging agents used in BCS, and was associated with a reduced need for second surgery in patients who underwent intraoperative additional excision of pFGS-guided shaves. These findings support further development and clinical performance assessment of pFGS in a prospective randomized trial. Trial Registration ClinicalTrials.gov Identifier: NCT03321929.
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Affiliation(s)
- E. Shelley Hwang
- Duke Cancer Institute and Duke University Health System, Durham, North Carolina
| | | | - Peter Blumencranz
- The Comprehensive Breast Care Center, BayCare Medical Group, Clearwater, Florida
| | - David Carr
- Novant Health, Winston-Salem, North Carolina
| | | | | | | | | | - Donna L. Dyess
- Mitchell Cancer Institute, University of South Alabama, Mobile
| | | | | | - Kelly Hunt
- MD Anderson Cancer Center, Houston, Texas
| | - Stephen Karp
- Beth Israel Lahey Health, Burlington, Massachusetts
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26
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Evolution of Frozen Section in Carcinoma Breast: Systematic Review. Int J Breast Cancer 2022; 2022:4958580. [PMID: 35655582 PMCID: PMC9152418 DOI: 10.1155/2022/4958580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The frozen section (FS) has been a good technique in surgical management of breast lesions since many years. But complete agreement and cooperation have not been achieved everywhere among surgeons and pathologists especially in the developing countries. FS undergoes continuous criticism due to various shortcomings but continued to be evaluated especially in developing countries. Objectives. This review was conducted to synthesize information on the use of frozen section in carcinoma breast. Data Sources. The MEDLINE database for frozen section since its origin and its implication in recent breast surgery techniques was studied. Study Eligibility Criteria. Sixty-five articles were reviewed with complete analysis on FS in both benign and malignant breast lesions. Study Appraisal and Synthesis Methods. The analysis of frozen section was done as a diagnostic tool in breast lesions, margin status in breast conservative surgery in carcinoma breast, and sentinel lymph node and use of immunohistochemistry for sentinel lymph node FS. Results. It was analysed that the FS gives accurate results in margin status analysis, decreasing rerecurrence. Conclusion. The accuracy of FSA, low recurrence rate, avoidance of reoperation, and good cosmesis are the key points of its use in breast conservative surgery. Its use in sentinel lymph node biopsy (SLNB) is equivocal. However, application of immunohistochemistry on frozen section of SLNB is an evolving trend in today’s era.
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27
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Development of an intraoperative breast cancer margin assessment method using quantitative fluorescence measurements. Sci Rep 2022; 12:8520. [PMID: 35595810 PMCID: PMC9122917 DOI: 10.1038/s41598-022-12614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/09/2022] [Indexed: 11/08/2022] Open
Abstract
Breast-conserving surgery has become the preferred treatment method for breast cancer. Surgical margin assessment is performed during surgery, as it can reduce local recurrence in the preserved breast. Development of reliable and lower-cost ex vivo cancer detection methods would offer several benefits for patient care. Here, a practical and quantitative evaluation method for the ex vivo fluorescent diagnosis of breast lesions was developed and confirmed through a three-step clinical study. Gamma-glutamyl-hydroxymethyl rhodamine green (gGlu-HMRG) has been reported to generate fluorescence in breast lesions. Using this probe, we constructed a reliable and reproducible procedure for the quantitative evaluation of fluorescence levels. We evaluated the reliability of the method by considering reproducibility, temperature sensitivity, and the effects of other clinicopathological factors. The results suggest that the fluorescence increase of gGlu-HMRG is a good indicator of the malignancy of breast lesions. However, the distributions overlapped. A 5 min reaction with this probe could be used to distinguish at least part of the normal breast tissue. This method did not affect the final pathological examination. In summary, our results indicate that the methods developed in this study may serve as a feasible intraoperative negative-margin assessment tool during breast-conserving surgery.
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28
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Jong LJS, de Kruif N, Geldof F, Veluponnar D, Sanders J, Vrancken Peeters MJTFD, van Duijnhoven F, Sterenborg HJCM, Dashtbozorg B, Ruers TJM. Discriminating healthy from tumor tissue in breast lumpectomy specimens using deep learning-based hyperspectral imaging. BIOMEDICAL OPTICS EXPRESS 2022; 13:2581-2604. [PMID: 35774331 PMCID: PMC9203093 DOI: 10.1364/boe.455208] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 06/15/2023]
Abstract
Achieving an adequate resection margin during breast-conserving surgery remains challenging due to the lack of intraoperative feedback. Here, we evaluated the use of hyperspectral imaging to discriminate healthy tissue from tumor tissue in lumpectomy specimens. We first used a dataset obtained on tissue slices to develop and evaluate three convolutional neural networks. Second, we fine-tuned the networks with lumpectomy data to predict the tissue percentages of the lumpectomy resection surface. A MCC of 0.92 was achieved on the tissue slices and an RMSE of 9% on the lumpectomy resection surface. This shows the potential of hyperspectral imaging to classify the resection margins of lumpectomy specimens.
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Affiliation(s)
- Lynn-Jade S. Jong
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- Equal contributors
| | - Naomi de Kruif
- Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands
- Equal contributors
| | - Freija Geldof
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Dinusha Veluponnar
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Joyce Sanders
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - Frederieke van Duijnhoven
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Henricus J. C. M. Sterenborg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands
| | - Theo J. M. Ruers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
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29
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van Vliet-Pérez SM, van de Berg NJ, Manni F, Lai M, Rijstenberg L, Hendriks BHW, Dankelman J, Ewing-Graham PC, Nieuwenhuyzen-de Boer GM, van Beekhuizen HJ. Hyperspectral Imaging for Tissue Classification after Advanced Stage Ovarian Cancer Surgery-A Pilot Study. Cancers (Basel) 2022; 14:cancers14061422. [PMID: 35326577 PMCID: PMC8946803 DOI: 10.3390/cancers14061422] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
The most important prognostic factor for the survival of advanced-stage epithelial ovarian cancer (EOC) is the completeness of cytoreductive surgery (CRS). Therefore, an intraoperative technique to detect microscopic tumors would be of great value. The aim of this pilot study is to assess the feasibility of near-infrared hyperspectral imaging (HSI) for EOC detection in ex vivo tissue samples. Images were collected during CRS in 11 patients in the wavelength range of 665−975 nm, and processed by calibration, normalization, and noise filtering. A linear support vector machine (SVM) was employed to classify healthy and tumorous tissue (defined as >50% tumor cells). Classifier performance was evaluated using leave-one-out cross-validation. Images of 26 tissue samples from 10 patients were included, containing 26,446 data points that were matched to histopathology. Tumorous tissue could be classified with an area under the curve of 0.83, a sensitivity of 0.81, a specificity of 0.70, and Matthew’s correlation coefficient of 0.41. This study paves the way to in vivo and intraoperative use of HSI during CRS. Hyperspectral imaging can scan a whole tissue surface in a fast and non-contact way. Our pilot study demonstrates that HSI and SVM learning can be used to discriminate EOC from surrounding tissue.
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Affiliation(s)
- Sharline M. van Vliet-Pérez
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (N.J.v.d.B.); (B.H.W.H.); (J.D.)
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Correspondence:
| | - Nick J. van de Berg
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (N.J.v.d.B.); (B.H.W.H.); (J.D.)
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (G.M.N.-d.B.); (H.J.v.B.)
| | - Francesca Manni
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands; (F.M.); (M.L.)
| | - Marco Lai
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands; (F.M.); (M.L.)
| | - Lucia Rijstenberg
- Department of Pathology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.R.); (P.C.E.-G.)
| | - Benno H. W. Hendriks
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (N.J.v.d.B.); (B.H.W.H.); (J.D.)
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (N.J.v.d.B.); (B.H.W.H.); (J.D.)
| | - Patricia C. Ewing-Graham
- Department of Pathology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.R.); (P.C.E.-G.)
| | - Gatske M. Nieuwenhuyzen-de Boer
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (G.M.N.-d.B.); (H.J.v.B.)
- Department of Gynecology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Heleen J. van Beekhuizen
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (G.M.N.-d.B.); (H.J.v.B.)
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Liu JJ, Wang Z, Nie LM, Zhu YY, Li G, Lin LL, Chen M, Zhang GJ. RGD-functionalised melanin nanoparticles for intraoperative photoacoustic imaging-guided breast cancer surgery. Eur J Nucl Med Mol Imaging 2022; 49:847-860. [PMID: 34505945 PMCID: PMC8803813 DOI: 10.1007/s00259-021-05545-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/24/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Obtaining tumour-free margins is critical for avoiding re-excision and reducing local recurrence following breast-conserving surgery; however, it remains challenging. Imaging-guided surgery provides precise detection of residual lesions and assists surgical resection. Herein, we described water-soluble melanin nanoparticles (MNPs) conjugated with cyclic Arg-Gly-Asp (cRGD) peptides for breast cancer photoacoustic imaging (PAI) and surgical navigation. METHODS The cRGD-MNPs were synthesised and characterized for morphology, photoacoustic characteristics and stability. Tumour targeting and toxicity of cRGD-MNPs were determined by using either breast cancer cells, MDA-MB-231 tumour-bearing mice or the FVB/N-Tg (MMTV-PyVT) 634Mul/J mice model. PAI was used to locate the tumour and guide surgical resection in MDA-MB-231 tumour-bearing mice. RESULTS The cRGD-MNPs exhibited excellent in vitro and in vivo tumour targeting with low toxicity. Intravenous administration of cRGD-MNPs to MDA-MB-231 tumour-bearing mice showed an approximately 2.1-fold enhancement in photoacoustic (PA) intensity at 2 h, and the ratio of the PA intensity at the tumour site to that in the surrounding normal tissue was 3.2 ± 0.1, which was higher than that using MNPs (1.7 ± 0.3). Similarly, the PA signal in the spontaneous breast cancer increased ~ 2.5-fold at 2 h post-injection of cRGD-MNPs in MMTV-PyVT transgenic mice. Preoperative PAI assessed tumour volume and offered three-dimensional (3D) reconstruction images for accurate surgical planning. Surgical resection following real-time PAI showed high consistency with histopathological analysis. CONCLUSION These results highlight that cRGD-MNP-mediated PAI provide a powerful tool for breast cancer imaging and precise tumour resection. cRGD-MNPs with fine PA properties have great potential for clinical translation.
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Affiliation(s)
- Jing-Jing Liu
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
| | - Zun Wang
- ChangJiang Scholar's Laboratory, Shantou University Medical College, Shantou, 515041, Guangdong, China
- Department of Breast and Thyroid Surgery, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, 518133, Guangdong, China
| | - Li-Ming Nie
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnosis & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China
- Department of Radiology and Optical Imaging Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Yuan-Yuan Zhu
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
| | - Ge Li
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
| | - Lin-Ling Lin
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
| | - Min Chen
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, 361101, Fujian, China
- Clinical Central Research Core, Xiang'an Hospital of Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
| | - Guo-Jun Zhang
- Cancer Center & Department of Breast and Thyroid Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an Road East, Xiamen, 361101, Fujian, China
- Xiamen Key Laboratory for Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, 361101, Fujian, China
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, 361101, Fujian, China
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Pradipta AR, Michiba H, Kubo A, Fujii M, Tanei T, Morimoto K, Shimazu K, Tanaka K. The second-generation click-to-sense probe for intraoperative diagnosis of breast cancer tissues based on acrolein targeting. BULLETIN OF THE CHEMICAL SOCIETY OF JAPAN 2022. [DOI: 10.1246/bcsj.20210387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ambara R. Pradipta
- Department of Chemical Science and Engineering, School of Materials and Chemical Technology, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro, 152-8552, Tokyo, Japan
- Biofunctional Synthetic Chemistry Laboratory, Cluster for Pioneering Research, RIKEN, 2-1 Hirosawa, Wako, 351-0198, Saitama, Japan
| | - Hiroyuki Michiba
- Department of Chemical Science and Engineering, School of Materials and Chemical Technology, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro, 152-8552, Tokyo, Japan
| | - Anna Kubo
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, 2-2-E10 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Motoko Fujii
- Department of Chemical Science and Engineering, School of Materials and Chemical Technology, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro, 152-8552, Tokyo, Japan
| | - Tomonori Tanei
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, 2-2-E10 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Koji Morimoto
- Biofunctional Synthetic Chemistry Laboratory, Cluster for Pioneering Research, RIKEN, 2-1 Hirosawa, Wako, 351-0198, Saitama, Japan
- Department of Food Design, College of Nutrition, Koshien University, Takarazuka, 665-0006, Hyogo, Japan
| | - Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, 2-2-E10 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Katsunori Tanaka
- Department of Chemical Science and Engineering, School of Materials and Chemical Technology, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro, 152-8552, Tokyo, Japan
- Biofunctional Synthetic Chemistry Laboratory, Cluster for Pioneering Research, RIKEN, 2-1 Hirosawa, Wako, 351-0198, Saitama, Japan
- Biofunctional Chemistry Laboratory, Alexander Butlerov Institute of Chemistry, Kazan Federal University, 18 Kremlyovskaya Street, 420008, Kazan, Russian Federation
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Onishi T, Mihara K, Matsuda S, Sakamoto S, Kuwahata A, Sekino M, Kusakabe M, Handa H, Kitagawa Y. Application of Magnetic Nanoparticles for Rapid Detection and In Situ Diagnosis in Clinical Oncology. Cancers (Basel) 2022; 14:cancers14020364. [PMID: 35053527 PMCID: PMC8774179 DOI: 10.3390/cancers14020364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 12/26/2022] Open
Abstract
Screening, monitoring, and diagnosis are critical in oncology treatment. However, there are limitations with the current clinical methods, notably the time, cost, and special facilities required for radioisotope-based methods. An alternative approach, which uses magnetic beads, offers faster analyses with safer materials over a wide range of oncological applications. Magnetic beads have been used to detect extracellular vesicles (EVs) in the serum of pancreatic cancer patients with statistically different EV levels in preoperative, postoperative, and negative control samples. By incorporating fluorescence, magnetic beads have been used to quantitatively measure prostate-specific antigen (PSA), a prostate cancer biomarker, which is sensitive enough even at levels found in healthy patients. Immunostaining has also been incorporated with magnetic beads and compared with conventional immunohistochemical methods to detect lesions; the results suggest that immunostained magnetic beads could be used for pathological diagnosis during surgery. Furthermore, magnetic nanoparticles, such as superparamagnetic iron oxide nanoparticles (SPIONs), can detect sentinel lymph nodes in breast cancer in a clinical setting, as well as those in gallbladder cancer in animal models, in a surgery-applicable timeframe. Ultimately, recent research into the applications of magnetic beads in oncology suggests that the screening, monitoring, and diagnosis of cancers could be improved and made more accessible through the adoption of this technology.
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Affiliation(s)
- Tatsuya Onishi
- Department of Breast Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa 277-8577, Chiba, Japan;
| | - Kisyo Mihara
- Department of Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki-ku, Kawasaki 210-0013, Kanagawa, Japan;
| | - Sachiko Matsuda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
- Correspondence: ; Tel.: +81-3-3353-1211
| | - Satoshi Sakamoto
- School of Life Science and Technology, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama 226-8501, Kanagawa, Japan;
| | - Akihiro Kuwahata
- Graduate School of Engineering, Tohoku University, 6-6-05 Aoba, Aramaki-aza, Aoba-ku, Sendai 980-8579, Miyagi, Japan;
| | - Masaki Sekino
- Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan;
| | - Moriaki Kusakabe
- Graduate School of Agricultural and Life Sciences, Research Center for Food Safety, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan;
- Matrix Cell Research Institute Inc., 1-35-3 Kamikashiwada, Ushiku 300-1232, Ibaraki, Japan
| | - Hiroshi Handa
- Department of Nanoparticle Translational Research, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan;
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
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Santilli AML, Ren K, Oleschuk R, Kaufmann M, Rudan J, Fichtinger G, Mousavi P. Application of Intraoperative Mass Spectrometry and Data Analytics for Oncological Margin Detection, A Review. IEEE Trans Biomed Eng 2022; 69:2220-2232. [PMID: 34982670 DOI: 10.1109/tbme.2021.3139992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A common phase of early-stage oncological treatment is the surgical resection of cancerous tissue. The presence of cancer cells on the resection margin, referred to as positive margin, is correlated with the recurrence of cancer and may require re-operation, negatively impacting many facets of patient outcomes. There exists a significant gap in the surgeons ability to intraoperatively delineate between tissues. Mass spectrometry methods have shown considerable promise as intraoperative tissue profiling tools that can assist with the complete resection of cancer. To do so, the vastness of the information collected through these modalities must be digested, relying on robust and efficient extraction of insights through data analysis pipelines. METHODS We review clinical mass spectrometry literature and prioritize intraoperatively applied modalities. We also survey the data analysis methods employed in these studies. RESULTS Our review outlines the advantages and shortcomings of mass spectrometry imaging and point-based tissue probing methods. For each modality, we identify statistical, linear transformation and machine learning techniques that demonstrate high performance in classifying cancerous tissues across several organ systems. A limited number of studies presented results captured intraoperatively. CONCLUSION Through continued research of data centric techniques, like mass spectrometry, and the development of robust analysis approaches, intraoperative margin assessment is becoming feasible. SIGNIFICANCE By establishing the relatively short history of mass spectrometry techniques applied to surgical studies, we hope to inform future applications and aid in the selection of suitable data analysis frameworks for the development of intraoperative margin detection technologies.
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Li W, Li X. Development of intraoperative assessment of margins in breast conserving surgery: a narrative review. Gland Surg 2022; 11:258-269. [PMID: 35242687 PMCID: PMC8825505 DOI: 10.21037/gs-21-652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/17/2021] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We intend to provide an informative and up-to-date summary on the topic of intraoperative assessment of margins in breast conserving surgery (BCS). Conventional methods as well as cutting-edge technologies are analyzed for their advantages and limitations in the hope that clinicians can turn to this for reference. This review can also offer guidance for technicians in the future design of intraoperative margin assessment tools. BACKGROUND Achieving negative margins during BCS is one of the vital factors for preventing local recurrence. Conducting intraoperative margin assessment can ensure negative margins to a large extent and possibly relieve patients of the anguish of re-interventions. In recent years, innovative methods for margin assessment during BCS are advancing rapidly. And there is a lack of summary regarding the development of intraoperative margin assessment in BCS. METHODS A PubMed search with keywords "intraoperative margin assessment" and "breast conserving surgery" was conducted. Relevant publications were screened manually for its title, abstract and even full text to determine its true relevance. Publications on neo-adjuvant therapy and intraoperative radiotherapy were excluded. References from the searched articles and other supplementary articles were also looked into. CONCLUSIONS Conventional methods for margin assessment yields stable outcome but its use is limited because of the demand on pathology staff and the trade-off between time and precision. Conventional imaging techniques pass the workload to radiologists at the cost of a significantly low duration of time. Involving artificial intelligence for image-based assessment is a further improvement. However, conventional imaging is inherently flawed in that occult lesions can't show on the image and the showing ones are ambiguous and open to interpretation. Unconventional techniques which base their judgment on cellular composition are more reassuring. Nonetheless, unconventional techniques should be subjected to clinical trials before putting into practice. And studies regarding comparison between conventional methods and unconventional methods are also needed to evaluate their relative efficacy.
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Affiliation(s)
- Wanheng Li
- First Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Xiru Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Diagnostic Value of Intraoperative Frozen Section in Breast-Conserving Surgery: A Systematic Review and Meta-analysis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.114082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Context: According to previous studies, using the frozen section procedure during breast surgery reduces the rate of error and the need for re-surgery. We aimed at performing a comprehensive systematic review and meta-analysis to provide reliable evidence on the diagnostic value of frozen section procedures in breast-conserving surgery (BCS). Data Sources: A thorough search was performed in PubMed, Embase, Cochrane Library, and Web of Science databases for human diagnostic studies that used the frozen section in BCS. Meta-analyses were done to find the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). Study Selection: Human diagnostic studies used the frozen section in breast-conserving surgery and studies that reported the sensitivity and specificity of the frozen section in BCS or contained data that could be calculated the desired parameters were selected for this meta-analysis. Data Extraction: Assessment of studies quality was done and data was extracted from included papers. Then, the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of included papers. Results: Thirty-five papers were entered into our study. The meta-analysis indicated the high sensitivity (83.47, 95%CI 79.61 - 87.32) and specificity (99.29, 95%CI 98.89 - 99.68) for the frozen section in BCS, which resulted in an accuracy of 93.77 (95%CI 92.45 - 95.10). We also found a significant PPV (93.26, 95%CI 91.25 - 95.27), NPV (92.17, 95%CI 90.22 - 94.11), PLR (7.99, 95%CI 6.01 - 9.96), and NLR (0.18, 95%CI 0.14 - 0.23). Conclusions: The findings showed that intraoperative frozen section analysis has high sensitivity and specificity for evaluating lumpectomy margins in patients with early-stage breast cancer and significantly reduces the need for re-operation. Accordingly, re-operation costs are not imposed on the patient and reduce the anxiety of the patients.
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Developing diagnostic assessment of breast lumpectomy tissues using radiomic and optical signatures. Sci Rep 2021; 11:21832. [PMID: 34750471 PMCID: PMC8575781 DOI: 10.1038/s41598-021-01414-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023] Open
Abstract
High positive margin rates in oncologic breast-conserving surgery are a pressing clinical problem. Volumetric X-ray scanning is emerging as a powerful ex vivo specimen imaging technique for analyzing resection margins, but X-rays lack contrast between non-malignant and malignant fibrous tissues. In this study, combined micro-CT and wide-field optical image radiomics were developed to classify malignancy of breast cancer tissues, demonstrating that X-ray/optical radiomics improve malignancy classification. Ninety-two standardized features were extracted from co-registered micro-CT and optical spatial frequency domain imaging samples extracted from 54 breast tumors exhibiting seven tissue subtypes confirmed by microscopic histological analysis. Multimodal feature sets improved classification performance versus micro-CT alone when adipose samples were included (AUC = 0.88 vs. 0.90; p-value = 3.65e-11) and excluded, focusing the classification task on exclusively non-malignant fibrous versus malignant tissues (AUC = 0.78 vs. 0.85; p-value = 9.33e-14). Extending the radiomics approach to high-dimensional optical data-termed "optomics" in this study-offers a promising optical image analysis technique for cancer detection. Radiomic feature data and classification source code are publicly available.
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Ueo H, Ueo H, Minoura I, Gamachi A, Doi T, Yamaguchi M, Yamashita T, Tsuda H, Moriya T, Yamaguchi R, Kozuka Y, Sasaki T, Masuda T, Kai Y, Kubota Y, Urano Y, Mori M, Mimori K. Clinical usefulness of a novel fluorescence technique for the intraoperative diagnosis of surgical margins in patients with breast cancer. Br J Surg 2021; 108:e340-e342. [PMID: 34428279 DOI: 10.1093/bjs/znab265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 11/12/2022]
Abstract
In both 5- and 15-min data, FI was significantly higher in malignant tissues than in benign tissues. The diagnostic accuracy was similar at 5 and 15 min. Therefore, the 5-min FI was enough applying in the further analyses.
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Affiliation(s)
- H Ueo
- Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Ueo Breast Cancer Hospital, Oita, Japan
| | - H Ueo
- Ueo Breast Cancer Hospital, Oita, Japan
| | - I Minoura
- Goryo Chemical, Inc., Sapporo, Japan
| | - A Gamachi
- Department of Pathology, Almeida Memorial Hospital, Oita, Japan
| | - T Doi
- Breast Cancer Centre, Shonan Memorial Hospital, Kamakura, Japan
| | - M Yamaguchi
- Department of Breast Surgery, JCHO Kurume General Hospital, Kurume, Japan
| | - T Yamashita
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Centre, Yokohama, Japan
| | - H Tsuda
- Department of Basic Pathology, National Defence Medical College, Tokorozawa, Japan
| | - T Moriya
- Department of Pathology, Kawasaki Medical School, Kurashiki, Japan
| | - R Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Centre, Kurume, Japan
| | - Y Kozuka
- Department of Pathology, Mie University Hospital, Tsu, Japan
| | - T Sasaki
- Department of Next-Generation Pathology Information and Networking, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - T Masuda
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
| | - Y Kai
- Ueo Breast Cancer Hospital, Oita, Japan
| | - Y Kubota
- Ueo Breast Cancer Hospital, Oita, Japan
| | - Y Urano
- Graduate School of Medicine and Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - M Mori
- Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - K Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan
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An Overview of Experience with Preoperative Skin Marking and Clip Insertion in Non-palpable Breast Cancer Lesions in a Tertiary Care Cancer Center and Its Impact on Breast Conservation Surgery. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Namdar ZM, Omidifar N, Arasteh P, Akrami M, Tahmasebi S, Nobandegani AS, Sedighi S, Zangouri V, Talei A. How accurate is frozen section pathology compared to permanent pathology in detecting involved margins and lymph nodes in breast cancer? World J Surg Oncol 2021; 19:261. [PMID: 34470649 PMCID: PMC8411544 DOI: 10.1186/s12957-021-02365-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 08/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Frozen section (FS) pathology has multiple limitations, and different institutions report variable experiences with the use of FS for diagnosis of tumor involvement. We aimed to compare the FS accuracy with that of permanent pathology (gold standard) regarding marginal involvement and lymph node status using data from the largest breast cancer registry in Iran. Methods In this retrospective study, women who had both FS and permanent pathology reports were included. The two pathology reports were cross compared with regard to the involvement of tumor margins and sentinel lymph nodes. Results Overall, 2786 patients entered the study. Mean age of patients was 48.96±11.44 years. A total of 1742 margins were analyzed. Accordingly, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FS pathology for detection of involvement of involved margins were 78.49%, 97.63%, 65.1%, and 98.7%, respectively. The accuracy and area under the curve (AUC) for FS pathology were 96.61% and 0.73 (95% CI: 0.64–0.831), respectively. A total of 1702 sentinel lymph node biopsies were assessed. Sensitivity, specificity, PPV, and NPV, of FS pathology for detection of lymph node involvement, were 87.1%, 98%, 95.5%, and 93.3%, respectively. Accuracy and AUC of FS for diagnosis of involved lymph nodes were 94.1% and 0.926 (95% CI: 0.909–0.942), respectively. Conclusion Frozen pathology is a suitable method for identifying involved sentinel lymph nodes in patients with breast cancer, but this method has a less than optimum efficacy for detecting and confirming marginal involvement.
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Affiliation(s)
| | - Navid Omidifar
- Clinical Education Research Center, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Sogol Sedighi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abdolrasoul Talei
- Clinical Education Research Center, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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Can supine breast magnetic resonance imaging help hit the target in extreme oncoplastic surgery? Eur J Surg Oncol 2021; 47:2788-2796. [PMID: 34412958 DOI: 10.1016/j.ejso.2021.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate the clinical value of supine magnetic resonance imaging (MRI) for tumor localization in breast cancer patients with large or multifocal tumors detected by prone MRI, scheduled for oncoplastic breast conserving surgery (OBCS). Outcomes were compared with those of patients who underwent wide local excision (WLE) or OBCS without MRI guidance. METHODS Over a 2-year period, consecutive patients with large or multifocal disease scheduled for OBCS with MRI-only findings were invited to participate (Group-1). Supplementary supine MRI was performed, and tumor margins were marked in the surgical position. Consecutive patients with early, non-palpable breast cancer who underwent WLE (Group-2) or OBCS (Group-3) were included for comparisons. The primary outcome was reoperation due to an insufficient margin. Secondary outcomes included surgical complications and delayed adjuvant treatment. RESULTS Altogether, 102 breasts (98 patients) were analyzed. All preoperative demographic data were comparable among the three groups. Multifocality, tumor-to-breast volume ratio, and the volume of excised breast tissue were significantly greater in Group-1 than in Groups-2 and 3. Operation time was longer and the need for axillary clearance or surgery for both breasts was more common in Groups-1 and 3 than in Group-2. Adequate margins were achieved in all patients in Groups-1 and 2, and one patient underwent re-excision in Group-3. CONCLUSIONS Supine MRI in the surgical position is a new, promising method to localize multifocal, large tumors visible on MRI. Its short-term outcomes were comparable with those of conventional WLE and OBCS.
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Kedarisetti P, Restall BS, Haven NJM, Martell MT, Cikaluk BD, Deschenes J, Zemp RJ. F-mode ultraviolet photoacoustic remote sensing for label-free virtual H&E histopathology using a single excitation wavelength. OPTICS LETTERS 2021; 46:3500-3503. [PMID: 34329209 DOI: 10.1364/ol.426543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
Photoacoustic remote sensing (PARS) is a novel all-optical imaging modality that allows for non-contact detection of initial photoacoustic pressures. Using 266-nm excitation pulses, ultraviolet PARS (UV-PARS) has previously demonstrated imaging contrast for cell nuclei in histological samples with <400nm resolution. In prior PARS-based imaging schemes, the signal amplitude at an interrogation point was determined by the maximum deflection from the DC scattering signal in response to a pulsed excitation. This method, however, does not take into consideration additional information encoded in the frequency domain of the recorded PARS signals. Here, we present a frequency domain technique called F-mode PARS that can be used to generate images with nuclear and cytoplasmic enhanced contrast, enabling label-free virtual hematoxylin-and-eosin-like microscopy, using only a single excitation wavelength. With F-mode processing, we have been able to demonstrate contrast-to-noise ratios of up to 38 dB between cell nuclei and surrounding cytoplasm, which represents up to a 25-dB improvement over previous implementations of UV-PARS systems.
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Chen K, Liu JQ, Wu W, Su FX, Zou Q, Song EW. Clinical practice guideline for breast-conserving surgery in patients with early-stage breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021. Chin Med J (Engl) 2021; 134:2143-2146. [PMID: 34133359 PMCID: PMC8478397 DOI: 10.1097/cm9.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Jie-Qiong Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Wei Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Feng-Xi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Qiang Zou
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Er-Wei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
- Department of Breast Surgery, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
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43
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Zheng A, Jin ZN, Cui MY, Chen B, Yao F, Jin F, Xu YY. Clinical practice guidelines for ductal carcinoma in situ: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021. Chin Med J (Engl) 2021; 134:1519-1521. [PMID: 34116527 PMCID: PMC8280070 DOI: 10.1097/cm9.0000000000001506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ang Zheng
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
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Pan H, Qian M, Chen H, Wang H, Yu M, Zhang K, Wang S, Deng J, Xu Y, Ling L, Ding Q, Xie H, Wang S, Zhou W. Precision Breast-Conserving Surgery With Microwave Ablation Guidance: A Pilot Single-Center, Prospective Cohort Study. Front Oncol 2021; 11:680091. [PMID: 34123849 PMCID: PMC8187871 DOI: 10.3389/fonc.2021.680091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Negative margins in breast-conserving surgery (BCS) are essential for preventing recurrence. The aim of this study was to determine the use of preoperative microwave ablation (MWA) in the guidance of BCS for early-stage breast cancer and access whether MWA could influence the rates of positive resection margins. Methods From 2016 to 2018, 22 women with T1/T2 invasive breast cancer were enrolled for MWA prospectively in the guidance of BCS. US-guided MWA was performed under local anesthesia, followed by BCS and sentinel lymph node biopsy (SLNB) one week after ablation. Women who underwent palpation-guided BCS directly were included as control, and propensity score matching analysis was applied. Results MWA was performed in 22 patients. Of the 21 MWA cases with effect information, the mean tumor size in US was 20.9 ± 6.2 mm (6-37 mm). Compared with control group (BCS directly), a lower rate of positive/close margins was observed in MWA guidance group (P = 0.018), and MWA caused a higher rate of accurate surgery (the largest margin ≤ 3 cm and the smallest margin ≥ 1mm, P = 0.042). Of these 21 patients treated with MWA, 18 were candidates for SLNB. And sentinel lymph nodes were successfully identified in all cases, and no recurrence was found with a mean follow-up of 23 months. Conclusion For patients with T1/T2 breast cancer, the application of preoperative MWA could guide BCS accurately without impairing SLNB. Clinical trials with long-term results are required to validate MWA in the guidance for breast cancer excision.
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Affiliation(s)
- Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengjia Qian
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Muxin Yu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Kai Zhang
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China.,Pancreatic Center & Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Pancreas Institute of Nanjing Medical University, Nanjing, China
| | - Siqi Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jing Deng
- Department of Ultrasonography, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lijun Ling
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qiang Ding
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wenbin Zhou
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
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House BJ, Kwon MJ, Schaefer JM, Barth CW, Solanki A, Davis SC, Gibbs SL. Clinically relevant dual probe difference specimen imaging (DDSI) protocol for freshly resected breast cancer specimen staining. BMC Cancer 2021; 21:440. [PMID: 33882909 PMCID: PMC8059239 DOI: 10.1186/s12885-021-08179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/05/2021] [Indexed: 11/12/2022] Open
Abstract
Background Re-excision rates following breast conserving surgery (BCS) remain as high as ~ 35%, with positive margins detected during follow-up histopathology. Additional breast cancer resection surgery is not only taxing on the patient and health care system, but also delays adjuvant therapies, increasing morbidity and reducing the likelihood of a positive outcome. The ability to precisely resect and visualize tumor margins in real time within the surgical theater would greatly benefit patients, surgeons and the health care system. Current tumor margin assessment technologies utilized during BCS involve relatively lengthy and labor-intensive protocols, which impede the surgical work flow. Methods In previous work, we have developed and validated a fluorescence imaging method termed dual probe difference specimen imaging (DDSI) to accurately detect benign and malignant tissue with direct correlation to the targeted biomarker expression levels intraoperatively. The DDSI method is currently on par with touch prep cytology in execution time (~ 15-min). In this study, the main goal was to shorten the DDSI protocol by decreasing tissue blocking and washing times to optimize the DDSI protocol to < 10-min whilst maintaining robust benign and malignant tissue differentiation. Results We evaluated the utility of the shortened DDSI staining methodology using xenografts grown from cell lines with varied epidermal growth factor receptor (EGFR) expression levels, comparing accuracy through receiver operator characteristic (ROC) curve analyses across varied tissue blocking and washing times. An optimized 8-min DDSI methodology was developed for future clinical translation. Conclusions Successful completion of this work resulted in substantial shortening of the DDSI methodology for use in the operating room, that provided robust, highly receptor specific, sensitive diagnostic capabilities between benign and malignant tissues.
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Affiliation(s)
- Broderick J House
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Marcus J Kwon
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Jasmin M Schaefer
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Connor W Barth
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Allison Solanki
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA. .,Knight Cancer Institute, Oregon Health & Science University, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR, 97201, USA.
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Koopmansch C, Noël JC, Maris C, Simon P, Sy M, Catteau X. Intraoperative Evaluation of Resection Margins in Breast-Conserving Surgery for In Situ and Invasive Breast Carcinoma. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:1178223421993459. [PMID: 33854326 PMCID: PMC8013925 DOI: 10.1177/1178223421993459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
Background: The challenge of breast-conserving surgery (BCS) is to remove the entire tumour with free margins and avoid secondary excision that may adversely affect the cosmetic outcome. Consequently, intraoperative evaluation of surgical margins is critical. The aims of this study were multiple. First, to analyse our methodology of intraoperative examination of the resection margins and to evaluate radiological and pathological methods in the assessment of the surgical margins. Second, to evaluate the factors associated with positive margins in our patient population. M&m: The data on the resection margin status of 290 patients who underwent BCS for invasive carcinoma or ductal carcinoma in situ (DCIS) between 2009 and 2016 were reviewed. Results: In the cohort of BCS with invasive carcinoma, the negative predictive value was 97.4% for intraoperative assessment by radiography and 81.8% for intraoperative assessment by pathology. The re-operation rate among cases without intraoperative assessment was 23.6% compared to 7.3% among cases with intraoperative assessment (P = .003). Margin status was significantly associated with tumour size, histological subtype (invasive lobular carcinoma), and multifocality. In the population of BCS with DCIS, margin status was significantly associated with preoperative localisation and intraoperative margin assessment (P = .03). Conclusion: There is no statistical difference between pathological and radiological intraoperative assessment. Tumour size, lobular subtype, and multifocality were found to be significantly associated with positive margins in cases with invasive carcinoma, whereas absence of intraoperative margin assessment was significantly associated with positive margins in cases with DCIS. Therefore, intraoperative margin assessment improves the likelihood of complete excision of the lesion.
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Affiliation(s)
- Caroline Koopmansch
- Department of Pathology, Pathology and Genetic Institute, Gosselies, Belgium
| | - Jean-Christophe Noël
- Department of Pathology, Erasme University Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Calliope Maris
- Department of Pathology, Erasme University Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Philippe Simon
- Department of Gynaecology, Erasme University Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Marième Sy
- Department of Radiology, Erasme University Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Xavier Catteau
- Department of Pathology, CUREPATH laboratory (CHIREC, CHU Tivoli), Jumet, Belgium
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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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Cartagena LC, McGuire K, Zot P, Pillappa R, Idowu M, Robila V. Breast-Conserving Surgeries With and Without Cavity Shave Margins Have Different Re-excision Rates and Associated Overall Cost: Institutional and Patient-Driven Decisions for Its Utilization. Clin Breast Cancer 2021; 21:e594-e601. [PMID: 33814286 DOI: 10.1016/j.clbc.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reducing the rate of margin positivity and reoperations remains a paramount goal in breast-conserving surgery (BCS). This study assesses the effectiveness of standard partial mastectomy with cavity shave margins (CSM) compared with partial mastectomy with selective margin resection (SPM), with regard to outcomes of the initial surgeries, re-excisions, and overall costs. PATIENTS AND METHODS This is a retrospective review of 122 eligible breast cancer patients who underwent BCS at one institution. The CSM and SPM groups each included 61 patients, matched for presurgical diagnoses and clinical stage. Data including margin status, rates and reason for re-excision, associated operation times, and costs were analyzed. RESULTS Patients undergoing CSM had less than half the rate of positive margins (PMs) (10% vs. 23%; P = .03) and re-excisions (8% vs. 23%; P = .02) compared with SPM. In the former group, the margin involvement was focal, and re-excisions were performed almost exclusively for PMs. For SPM, the majority (92%) of PMs were on the main lumpectomy specimen rather than the selective margins, and re-excisions included, in addition to PMs, extensive or multifocal negative but close margins. Reduced breast tissue volumes were removed with CSM, particularly for patients undergoing a single surgery (47 vs. 165 cm3; P < .001). The initial surgery with CSM is on average 27% more costly than that for SPM (P < .001), due to the increased pathology costs which are partially offset by the increased re-excision rates in SPM. CONCLUSION Circumferential cavity shaving, associated with consistent lower PMs, tissue volumes excised, and re-excision rates, is appropriate for routine implementation as a method offering superior surgical outcomes.
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Affiliation(s)
| | - Kandace McGuire
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
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Performance of a novel protease-activated fluorescent imaging system for intraoperative detection of residual breast cancer during breast conserving surgery. Breast Cancer Res Treat 2021; 187:145-153. [PMID: 33611664 PMCID: PMC8062324 DOI: 10.1007/s10549-021-06106-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/18/2021] [Indexed: 12/31/2022]
Abstract
Purpose Safe breast cancer lumpectomies require microscopically clear margins. Real-time margin assessment options are limited, and 20–40% of lumpectomies have positive margins requiring re-excision. The LUM Imaging System previously showed excellent sensitivity and specificity for tumor detection during lumpectomy surgery. We explored its impact on surgical workflow and performance across patient and tumor types. Methods We performed IRB-approved, prospective, non-randomized studies in breast cancer lumpectomy procedures. The LUM Imaging System uses LUM015, a protease-activated fluorescent imaging agent that identifies residual tumor in the surgical cavity walls. Fluorescent cavity images were collected in real-time and analyzed using system software. Results Cavity and specimen images were obtained in 55 patients injected with LUM015 at 0.5 or 1.0 mg/kg and in 5 patients who did not receive LUM015. All tumor types were distinguished from normal tissue, with mean tumor:normal (T:N) signal ratios of 3.81–5.69. T:N ratios were 4.45 in non-dense and 4.00 in dense breasts (p = 0.59) and 3.52 in premenopausal and 4.59 in postmenopausal women (p = 0.19). Histopathology and tumor receptor testing were not affected by LUM015. Falsely positive readings were more likely when tumor was present < 2 mm from the adjacent specimen margin. LUM015 signal was stable in vivo at least 6.5 h post injection, and ex vivo at least 4 h post excision. Conclusions Intraoperative use of the LUM Imaging System detected all breast cancer subtypes with robust performance independent of menopausal status and breast density. There was no significant impact on histopathology or receptor evaluation.
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Balasundaram G, Krafft C, Zhang R, Dev K, Bi R, Moothanchery M, Popp J, Olivo M. Biophotonic technologies for assessment of breast tumor surgical margins-A review. JOURNAL OF BIOPHOTONICS 2021; 14:e202000280. [PMID: 32951321 DOI: 10.1002/jbio.202000280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
Breast conserving surgery (BCS) offering similar surgical outcomes as mastectomy while retaining breast cosmesis is becoming increasingly popular for the management of early stage breast cancers. However, its association with reoperation rates of 20% to 40% following incomplete tumor removal warrants the need for a fast and accurate intraoperative surgical margin assessment tool that offers cellular, structural and molecular information of the whole specimen surface to a clinically relevant depth. Biophotonic technologies are evolving to qualify as such an intraoperative tool for clinical assessment of breast cancer surgical margins at the microscopic and macroscopic scale. Herein, we review the current research in the application of biophotonic technologies such as photoacoustic imaging, Raman spectroscopy, multimodal multiphoton imaging, diffuse optical imaging and fluorescence imaging using medically approved dyes for breast cancer detection and/or tumor subtype differentiation toward intraoperative assessment of surgical margins in BCS specimens, and possible challenges in their route to clinical translation.
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Affiliation(s)
- Ghayathri Balasundaram
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | | | - Ruochong Zhang
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Kapil Dev
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Renzhe Bi
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Mohesh Moothanchery
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jürgen Popp
- Leibniz Institute of Photonic Technology, Jena, Germany
- Institute of Physical Chemistry and Abbe Center of Photonics, University Jena, Jena, Germany
| | - Malini Olivo
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
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