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Ma J, Chen K, Li S, Zhu L, Yu Y, Li J, Ma J, Ouyang J, Wu Z, Tan Y, He Z, Liu H, Pan Z, Li H, Liu Q, Song E. MRI-based radiomic models to predict surgical margin status and infer tumor immune microenvironment in breast cancer patients with breast-conserving surgery: a multicenter validation study. Eur Radiol 2024; 34:1774-1789. [PMID: 37658888 DOI: 10.1007/s00330-023-10144-x] [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: 04/07/2022] [Revised: 05/18/2023] [Accepted: 07/08/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Accurate preoperative estimation of the risk of breast-conserving surgery (BCS) resection margin positivity would be beneficial to surgical planning. In this multicenter validation study, we developed an MRI-based radiomic model to predict the surgical margin status. METHODS We retrospectively collected preoperative breast MRI of patients undergoing BCS from three hospitals (SYMH, n = 296; SYSUCC, n = 131; TSPH, n = 143). Radiomic-based model for risk prediction of the margin positivity was trained on the SYMH patients (7:3 ratio split for the training and testing cohorts), and externally validated in the SYSUCC and TSPH cohorts. The model was able to stratify patients into different subgroups with varied risk of margin positivity. Moreover, we used the immune-radiomic models and epithelial-mesenchymal transition (EMT) signature to infer the distribution patterns of immune cells and tumor cell EMT status under different marginal status. RESULTS The AUCs of the radiomic-based model were 0.78 (0.66-0.90), 0.88 (0.79-0.96), and 0.76 (0.68-0.84) in the testing cohort and two external validation cohorts, respectively. The actual margin positivity rates ranged between 0-10% and 27.3-87.2% in low-risk and high-risk subgroups, respectively. Positive surgical margin was associated with higher levels of EMT and B cell infiltration in the tumor area, as well as the enrichment of B cells, immature dendritic cells, and neutrophil infiltration in the peritumoral area. CONCLUSIONS This MRI-based predictive model can be used as a reliable tool to predict the risk of margin positivity of BCS. Tumor immune-microenvironment alteration was associated with surgical margin status. CLINICAL RELEVANCE STATEMENT This study can assist the pre-operative planning of BCS. Further research on the tumor immune microenvironment of different resection margin states is expected to develop new margin evaluation indicators and decipher the internal mechanism. KEY POINTS • The MRI-based radiomic prediction model (CSS model) incorporating features extracted from multiple sequences and segments could estimate the margin positivity risk of breast-conserving surgery. • The radiomic score of the CSS model allows risk stratification of patients undergoing breast-conserving surgery, which could assist in surgical planning. • With the help of MRI-based radiomics to estimate the components of the immune microenvironment, for the first time, it is found that the margin status of breast-conserving surgery is associated with the infiltration of immune cells in the microenvironment and the EMT status of breast tumor cells.
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Affiliation(s)
- Jiafan Ma
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Breast Tumor Center, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Breast Tumor Center, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
- Artificial Intelligence Lab, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Shunrong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Breast Tumor Center, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Breast Tumor Center, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Yunfang Yu
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Jingwu Li
- Department of Breast Surgery, Tangshan People's Hospital, Tangshan, 063001, Hebei, China
| | - Jie Ma
- Department of Breast Surgery, Tangshan People's Hospital, Tangshan, 063001, Hebei, China
| | - Jie Ouyang
- Department of Breast Surgery, Tungwah Hospital, Sun Yat-sen University, Dongguan, 523413, China
| | - Zhuo Wu
- Artificial Intelligence Lab, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Yujie Tan
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Zifan He
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Haiqing Liu
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Zhilong Pan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Breast Tumor Center, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Haojiang Li
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
| | - Qiang Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
- Breast Tumor Center, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China.
| | - Erwei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
- Breast Tumor Center, Yat-sen Breast Tumor Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China.
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Zhao R, Zhang J, Gao J. Blood flow on ultrasound imaging is a predictor of lump margin status in breast-conserving patients: a retrospective matching study. Eur J Med Res 2023; 28:357. [PMID: 37730626 PMCID: PMC10510181 DOI: 10.1186/s40001-023-01356-4] [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: 01/27/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE This study investigated the relationship between breast ultrasound features and lump margin status in breast-conserving patients. METHODS A single-institution database and medical records system were searched to identify patients who had undergone breast-conserving surgery between 2015 and 2022. Patients were divided into case and control groups based on their postoperative margin status, and different matching methods [case-control matching (CCM) and propensity score matching (PSM)] were used to match the cases and controls at a ratio of 1:1. RESULTS Before matching, patients with positive margins were more likely to have a tumor with increased blood flow (OR = 2.90, 95% CI 1.83-4.61, p < 0.001) and microcalcifications (OR = 2.22, 95% CI 1.44-3.42, p < 0.001). Among the 83 pairs of CCM subjects, patients with positive margins were prone to increased blood flow (p = 0.007) and crab sign (p = 0.040). In addition, there was a significant difference in blood flow (p = 0.030) among PSM subjects. After adjusting for the unbalanced factors, the same results were obtained. CONCLUSIONS Ultrasound blood flow significantly predicts the status of breast-conserving margins, but further studies are required to verify our findings.
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Affiliation(s)
- Rong Zhao
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Jianyong Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Jinnan Gao
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
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Zhao R, Xing J, Gao J. Development and Validation of a Prediction Model for Positive Margins in Breast-Conserving Surgery. Front Oncol 2022; 12:875665. [PMID: 35646633 PMCID: PMC9133412 DOI: 10.3389/fonc.2022.875665] [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: 02/14/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background The chances of second surgery due to positive margins in patients receiving breast-conversing surgery (BCS) were about 20-40%. This study aims to develop and validate a nomogram to predict the status of breast-conserving margins. Methods The database identified patients with core needle biopsy-proven ductal carcinoma in situ (DCIS) or invasive breast carcinoma who underwent BCS in Shanxi Bethune Hospital between January 1, 2015 and December 31, 2021 (n = 573). The patients were divided into two models: (1) The first model consists of 398 patients who underwent BCS between 2015 and 2019; (2) The validation model consists of 175 patients who underwent BCS between 2020 and 2021. The development of the nomogram was based on the findings of multivariate logistic regression analysis. Discrimination was assessed by computing the C-index. The Hosmer-Lemeshow goodness-of-fit test was used to validate the calibration performance. Results The final multivariate regression model was developed as a nomogram, including blood flow signals (OR = 2.88, p = 0.001), grade (OR = 2.46, p = 0.002), microcalcifications (OR = 2.39, p = 0.003), tumor size in ultrasound (OR = 2.12, p = 0.011) and cerbB-2 status (OR = 1.99, p = 0.042). C-indices were calculated of 0.71 (95% CI: 0.64-0.78) and 0.68 (95% CI: 0.59-0.78) for the modeling and the validation group, respectively. The calibration of the model was considered adequate in the validation group (p > 0.05). Conclusion We developed a nomogram that enables the estimation of the preoperative risk of positive BCS margins. Our nomogram provides a valuable tool for identifying high-risk patients who might have to undergo a wider excision.
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Affiliation(s)
| | | | - Jinnan Gao
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
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4
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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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Radhakrishna S, Agarwal S, Parikh PM, Kaur K, Panwar S, Sharma S, Dey A, Saxena KK, Chandra M, Sud S. Role of magnetic resonance imaging in breast cancer management. South Asian J Cancer 2020; 7:69-71. [PMID: 29721466 PMCID: PMC5909298 DOI: 10.4103/sajc.sajc_104_18] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Magnetic resonance imaging (MRI) of the breast is primarily used as a supplemental tool to breast screening with mammography or ultrasound. A breast MRI is mainly used for women who have been diagnosed with breast cancer, to help measure the size of the cancer, look for other tumors in the breast, and to check for tumors in the opposite breast. For certain women at high risk for breast cancer, a screening MRI is recommended along with a yearly mammogram. MRI is known to give some false positive results which mean more test and/or biopsies for the patient. Thus, although breast MRI is useful for women at high risk, it is rarely recommended as a screening test for women at average risk of breast cancer. Also, breast MRI does not show calcium deposits, known as micro-calcifications which can be a sign of breast cancer.
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Affiliation(s)
- Selvi Radhakrishna
- Department of Surgery, Chennai Breast Center, Chennai, Tamil Nadu, India
| | - S Agarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - K Kaur
- Department of Surgical Oncology, Medanta Hospital, Gurgaon, Haryana, India
| | - Shikha Panwar
- Department of Radiology, BLK Super Specialty Hospital, New Delhi, India
| | - Shelly Sharma
- Department of Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Dey
- Department of Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - K K Saxena
- Department of Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Madhavi Chandra
- Department of Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Seema Sud
- Department of CT Scan and MRI, Sir Ganga Ram Hospital, New Delhi, India
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6
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Zheng S, Qi L, Guang-Qiang Z, Ming-Ming S, Chun-Hong X. Role of Magnetic Resonance Imaging in Predicting Residual Breast Cancer After Vacuum-Assisted Breast Biopsy. Am Surg 2020; 87:885-891. [PMID: 33284052 DOI: 10.1177/0003134820952430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aims to evaluate the effectiveness of breast magnetic resonance imaging (MRI) in detecting residual breast cancer in patients after vacuum-assisted breast biopsy (VABB). METHODS Between 2012 and 2019, 26 patients with breast cancer who underwent VABB were enrolled. Breast MRI was conducted after VABB. Imaging findings were then compared with the histopathological results. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. RESULTS Residual cancer was confirmed histologically in 8 of the 26 patients after VABB. The overall sensitivity, specificity, PPV, NPV, and accuracy of MRI for diagnosing residual cancer were 79.9%, 73.0%, 87.1%, 61.3%, and 77.8%, respectively. The sensitivity and NPV improved to 100%, when the number of biopsy specimens was larger than five. CONCLUSION Breast MRI showed high sensitivity and NPV in detecting residual breast tumor after VABB.
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Affiliation(s)
- Sun Zheng
- Department of Thyroid and Breast Surgery, Weifang Hospital of Traditional Chinese Medicine, China
| | - Liu Qi
- Department of Thyroid and Breast Surgery, Weifang Hospital of Traditional Chinese Medicine, China
| | - Zhang Guang-Qiang
- Department of Thyroid and Breast Surgery, Weifang Hospital of Traditional Chinese Medicine, China
| | - Shi Ming-Ming
- Department of Thyroid and Breast Surgery, Weifang Hospital of Traditional Chinese Medicine, China
| | - Xu Chun-Hong
- Department of Thyroid and Breast Surgery, Weifang Hospital of Traditional Chinese Medicine, China
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7
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Moreira IC, Ventura SR, Ramos I, Fougo JL, Rodrigues PP. Preoperative localisation techniques in breast conservative surgery: A systematic review and meta-analysis. Surg Oncol 2020; 35:351-373. [DOI: 10.1016/j.suronc.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 01/20/2023]
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8
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Diagnostic Accuracy of Cross-Polarization OCT and OCT-Elastography for Differentiation of Breast Cancer Subtypes: Comparative Study. Diagnostics (Basel) 2020; 10:diagnostics10120994. [PMID: 33255263 PMCID: PMC7760404 DOI: 10.3390/diagnostics10120994] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022] Open
Abstract
The possibility to assess molecular-biological and morphological features of particular breast cancer types can improve the precision of resection margin detection and enable accurate determining of the tumor aggressiveness, which is important for treatment selection. To enable reliable differentiation of breast-cancer subtypes and evaluation of resection margin, without performing conventional histological procedures, here we apply cross-polarization optical coherence tomography (CP-OCT) and compare it with a novel variant of compressional optical coherence elastography (C-OCE) in terms of the diagnostic accuracy (Ac) with histological verification. The study used 70 excised breast cancer specimens with different morphological structure and molecular status (Luminal A, Luminal B, Her2/Neo+, non-luminal and triple-negative cancer). Our first aim was to formulate convenient criteria of visual assessment of CP-OCT and C-OCE images intended (i) to differentiate tumorous and non-tumorous tissues and (ii) to enable more precise differentiation among different malignant states. We identified such criteria based on the presence of heterogeneities and characteristics of signal attenuation in CP-OCT images, as well as the presence of inclusions/mosaic structures combined with visually feasible assessment of several stiffness grades in C-OCE images. Secondly, we performed a blinded reader study of the Ac of C-OCE versus CP-OCT, for delineation of tumorous versus non-tumorous tissues followed by identification of breast cancer subtypes. For tumor detection, C-OCE showed higher specificity than CP-OCT (97.5% versus 93.3%) and higher Ac (96.0 versus 92.4%). For the first time, the Ac of C-OCE and CP-OCT were evaluated for differentiation between non-invasive and invasive breast cancer (90.4% and 82.5%, respectively). Furthermore, for invasive cancers, the difference between invasive but low-aggressive and highly-aggressive subtypes can be detected. For differentiation between non-tumorous tissue and low-aggressive breast-cancer subtypes, Ac was 95.7% for C-OCE and 88.1% for CP-OCT. For differentiation between non-tumorous tissue and highly-aggressive breast cancers, Ac was found to be 98.3% for C-OCE and 97.2% for CP-OCT. In all cases C-OCE showed better diagnostic parameters independently of the tumor type. These findings confirm the high potential of OCT-based examinations for rapid and accurate diagnostics during breast conservation surgery.
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Kennedy KM, Zilkens R, Allen WM, Foo KY, Fang Q, Chin L, Sanderson RW, Anstie J, Wijesinghe P, Curatolo A, Tan HEI, Morin N, Kunjuraman B, Yeomans C, Chin SL, DeJong H, Giles K, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Diagnostic Accuracy of Quantitative Micro-Elastography for Margin Assessment in Breast-Conserving Surgery. Cancer Res 2020; 80:1773-1783. [PMID: 32295783 DOI: 10.1158/0008-5472.can-19-1240] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/09/2019] [Accepted: 02/14/2020] [Indexed: 01/16/2023]
Abstract
Inadequate margins in breast-conserving surgery (BCS) are associated with an increased likelihood of local recurrence of breast cancer. Currently, approximately 20% of BCS patients require repeat surgery due to inadequate margins at the initial operation. Implementation of an accurate, intraoperative margin assessment tool may reduce this re-excision rate. This study determined, for the first time, the diagnostic accuracy of quantitative micro-elastography (QME), an optical coherence tomography (OCT)-based elastography technique that produces images of tissue microscale elasticity, for detecting tumor within 1 mm of the margins of BCS specimens. Simultaneous OCT and QME were performed on the margins of intact, freshly excised specimens from 83 patients undergoing BCS and on dissected specimens from 7 patients undergoing mastectomy. The resulting three-dimensional images (45 × 45 × 1 mm) were coregistered with postoperative histology to determine tissue types present in each scan. Data from 12 BCS patients and the 7 mastectomy patients served to build a set of images for reader training. One hundred and fifty-four subimages (10 × 10 × 1 mm) from the remaining 71 BCS patients were included in a blinded reader study, which resulted in 69.0% sensitivity and 79.0% specificity using OCT images, versus 92.9% sensitivity and 96.4% specificity using elasticity images. The quantitative nature of QME also facilitated development of an automated reader, which resulted in 100.0% sensitivity and 97.7% specificity. These results demonstrate high accuracy of QME for detecting tumor within 1 mm of the margin and the potential for this technique to improve outcomes in BCS. SIGNIFICANCE: An optical imaging technology probes breast tissue elasticity to provide accurate assessment of tumor margin involvement in breast-conserving surgery.
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Affiliation(s)
- Kelsey M Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, 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, Australia.,School of Medicine, The University of Western Australia, Perth, Australia
| | - Wes M Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, 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, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, 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, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Rowan W Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - James Anstie
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Philip Wijesinghe
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Andrea Curatolo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Hsern Ern I Tan
- School of Medicine, The University of Western Australia, Perth, Australia
| | | | | | - Chris Yeomans
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
| | - Synn Lynn Chin
- Breast Centre, Fiona Stanley Hospital, Murdoch, Australia
| | - Helen DeJong
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, Australia
| | | | - Benjamin F Dessauvagie
- School of Medicine, The University of Western Australia, Perth, Australia.,PathWest, Fiona Stanley Hospital, Murdoch, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
| | - Christobel M Saunders
- School of Medicine, The University of Western Australia, Perth, Australia.,Breast Centre, Fiona Stanley Hospital, Murdoch, Australia.,Breast Clinic, Royal Perth Hospital, Perth, Australia
| | - 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, Australia. .,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
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10
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Nietz S, Ruff P, Chen WC, O'Neil DS, Norris SA. Quality indicators for the diagnosis and surgical management of breast cancer in South Africa. Breast 2020; 54:187-196. [PMID: 33120084 PMCID: PMC7593621 DOI: 10.1016/j.breast.2020.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/19/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Quality indicators (QIs) for breast cancer care have been developed and applied in high-income countries and contributed to improved quality of care and patient outcomes over time. MATERIALS AND METHODS A modified Delphi process was used to derive expert consensus. Potential QIs were rated by a panel of 17 breast cancer experts from various subspecialties and across South African provinces. Each QI was rated according to importance to measure, scientific acceptability and feasibility. Scoring ranged from 1 (no agreement) to 5 (strong agreement). Inclusion thresholds were set a priori at mean ratings ≥4 with a coefficient variation of ≥25%. Levels of evidence were determined for each indicator. RESULTS The literature review identified 790 potential QIs. After categorisation and removal of duplicates, 52 remained for panel review. There was strong consensus for 47 which were merged to 30 QIs by exclusion of similar indicators and indicator grouping. The final set included eight QIs with level I or II evidence and two QIs with level III evidence which were deemed "mandatory" due to clinical priority and impact on care. The remaining QIs with lower-level evidence were grouped as eight "recommended" QIs (regarded as standard of care) and twelve "optional" QIs (not regarded as standard of care). CONCLUSION A regional set of QIs was developed to facilitate standardised treatment and auditing of surgical care for breast cancer patients in South Africa. Routine monitoring of the ten mandatory QIs, which were selected to have the most substantial impact on patient outcome, is proposed.
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Affiliation(s)
- Sarah Nietz
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa.
| | - Paul Ruff
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa; Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenlong Carl Chen
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa; National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel S O'Neil
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, USA; Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, USA
| | - Shane A Norris
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa; SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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11
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Perera N, Bourke AG. The technique and accuracy of breast specimen ultrasound in achieving clear margins in breast conserving surgery. J Med Imaging Radiat Oncol 2020; 64:747-755. [DOI: 10.1111/1754-9485.13077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Natalie Perera
- School of Medicine The University of Western Australia Perth Western Australia Australia
| | - Anita G Bourke
- School of Medicine The University of Western Australia Perth Western Australia Australia
- Breast Centre Department of Diagnostic and Interventional Radiology Sir Charles Gairdner Hospital Perth Western Australia Australia
- BreastScreen WA Perth Western Australia Australia
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12
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Hermann N, Haas I, Malinger P, Kaufman Z. Margin assessment before intraoperative radiotherapy during breast conserving surgery-Does the addition of MarginProbe decrease the need for addition of fractionated whole breast radiation? Breast J 2020; 26:1343-1346. [PMID: 32367618 DOI: 10.1111/tbj.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 01/16/2023]
Abstract
When performing Breast Conserving Surgery (BCS) with Intraoperative Radiation Therapy (IORT), positive resection margin necessitates not only re-lumpectomy-but also the addition of fractionated whole breast radiation. This retrospective study of 106 patients undergoing BCS and IORT aims to evaluate intraoperative margin assessment use in our center, and the contribution of the MarginProbe device (MP) to achieving negative surgical margins. Eleven out of 106 lumpectomy specimens had a total of 17 margins positive for tumor cells. Intraoperative gross pathology identified 6 (43%) involved margins, MarginProbe detected 8 (50%), and their combined use allowed for detection of 12 (70.5%) involved margins. In conclusion, the adjunctive use of intraoperative gross pathology and MarginProbe reduced the number of lumpectomies with positive resection margins by more than 50%, decreasing the need for re-lumpectomy and the addition of whole breast radiation.
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Affiliation(s)
- Naama Hermann
- Surgical Ward B, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Haas
- Surgical Ward A, Meir Medical Center, Kfar Saba, Israel
| | | | - Zvi Kaufman
- Surgical Ward B, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Current Procedural Terminology Coding in an Academic Breast Pathology Service: An Illustration of the Undervaluation of Breast Pathology. Am J Surg Pathol 2020; 43:1510-1517. [PMID: 31385852 DOI: 10.1097/pas.0000000000001337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many physicians share the perception that the work required to evaluate breast pathology specimens is undervalued by Current Procedural Terminology (CPT) codes. To examine this issue, we compared slide volumes from an equal number of breast and nonbreast specimens assigned 88305, 88307, or 88309 CPT codes during four 2.5-week periods over 1 year. For each specimen, a number of initial hematoxylin and eosin-stained sections (H&Es), preordered additional H&E sections (levels), H&E sections ordered after initial slide review (recuts), and specimen type were recorded. Slides associated with ancillary stains were not considered. In total, 911 breast and 911 nonbreast specimens, each assigned 88305 (n=580), 88307 (n=320), and 88309 (n=11) CPT codes, were compared. Breast 88305 specimens were mainly core biopsies and margins and generated 2.3 and 6.4 times the H&Es and recuts, respectively, than did nonbreast specimens (P<0.01). Breast 88307 specimens were mainly lymph nodes and lumpectomies and generated 1.8 times the total slides than did nonbreast specimens (P<0.01). Eleven modified radical mastectomies (88309) generated 2.1 times the total slides than nonbreast 88309 specimens (P<0.01). In total (n=911 in each cohort), breast specimens generated 1.9, 4.0, and 1.7 times the H&Es, recuts, and total slides (P<0.01) than did nonbreast specimens. At our academic institution, the slide volume for breast specimens is nearly twice that of similarly coded nonbreast specimens. These results have significant implications for workload management and assessing pathologist productivity, particularly in subspecialty practices.
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14
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Smith BL, Lanahan CR, Specht MC, Kelly BN, Brown C, Strasfeld DB, Ferrer JM, Rai U, Tang R, Rice-Stitt T, Biernacka A, Brachtel EF, Gadd MA. Feasibility Study of a Novel Protease-Activated Fluorescent Imaging System for Real-Time, Intraoperative Detection of Residual Breast Cancer in Breast Conserving Surgery. Ann Surg Oncol 2020; 27:1854-1861. [PMID: 31898104 PMCID: PMC7210242 DOI: 10.1245/s10434-019-08158-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Obtaining tumor-free margins is critical to prevent recurrence after lumpectomy for breast cancer. Unfortunately, current approaches leave positive margins that require second surgeries in 20-40% of patients. We assessed the LUM Imaging System for real-time, intraoperative detection of residual tumor. METHODS Breast lumpectomy cavity walls and excised specimens were assessed with the LUM Imaging System after 1 mg/kg intravenous LUM015, a protease-activatable fluorescent agent. Fluorescence at potential sites of residual tumor in lumpectomy cavity walls was evaluated intraoperatively with a sterile hand-held probe, with real-time predictive results displayed on a monitor intraoperatively, and later correlated with histopathology. RESULTS In vivo lumpectomy cavities and excised specimens were imaged after LUM015 injection in 45 women undergoing breast cancer surgery. Invasive ductal and lobular cancers and intraductal cancer (DCIS) were included. A total of 570 cavity margin surfaces in 40 patients were used for algorithm development. Image analysis and display took approximately 1 s per 2.6-cm-diameter circular margin surface. All breast cancer subtypes could be distinguished from adjacent normal tissue. For all imaged cavity surfaces, sensitivity for tumor detection was 84%. Among 8 patients with positive margins after standard surgery, sensitivity for residual tumor detection was 100%; 2 of 8 were spared second surgeries because additional tissue was excised at sites of LUM015 signal. Specificity was 73%, with some benign tissues showing elevated fluorescent signal. CONCLUSIONS The LUM015 agent and LUM Imaging System allow rapid identification of residual tumor in the lumpectomy cavity of breast cancer patients and may reduce rates of positive margins.
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Affiliation(s)
- Barbara L Smith
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
| | - Conor R Lanahan
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle C Specht
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Bridget N Kelly
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Carson Brown
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Upahvan Rai
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Rong Tang
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Travis Rice-Stitt
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Anna Biernacka
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Elena F Brachtel
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Michele A Gadd
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
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15
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Davoine E, Dion L, Nyangoh Timoh K, Beraud E, Tas P, Tavenard A, Laviolle B, Perrin C, Foucher F, Levêque J, Lavoué V. Predictive factors associated with involved margins in breast cancer treated with neoadjuvant chemotherapy followed by breast-conserving therapy. J Gynecol Obstet Hum Reprod 2019; 48:467-472. [DOI: 10.1016/j.jogoh.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/03/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
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16
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Sanderson RW, Curatolo A, Wijesinghe P, Chin L, Kennedy BF. Finger-mounted quantitative micro-elastography. BIOMEDICAL OPTICS EXPRESS 2019; 10:1760-1773. [PMID: 31086702 PMCID: PMC6484987 DOI: 10.1364/boe.10.001760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 05/14/2023]
Abstract
We present a finger-mounted quantitative micro-elastography (QME) probe, capable of measuring the elasticity of biological tissue in a format that avails of the dexterity of the human finger. Finger-mounted QME represents the first demonstration of a wearable elastography probe. The approach realizes optical coherence tomography-based elastography by focusing the optical beam into the sample via a single-mode fiber that is fused to a length of graded-index fiber. The fiber is rigidly affixed to a 3D-printed thimble that is mounted on the finger. Analogous to manual palpation, the probe compresses the tissue through the force exerted by the finger. The resulting deformation is measured using optical coherence tomography. Elasticity is estimated as the ratio of local stress at the sample surface, measured using a compliant layer, to the local strain in the sample. We describe the probe fabrication method and the signal processing developed to achieve accurate elasticity measurements in the presence of motion artifact. We demonstrate the probe's performance in motion-mode scans performed on homogeneous, bi-layer and inclusion phantoms and its ability to measure a thermally-induced increase in elasticity in ex vivo muscle tissue. In addition, we demonstrate the ability to acquire 2D images with the finger-mounted probe where lateral scanning is achieved by swiping the probe across the sample surface.
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Affiliation(s)
- Rowan W. Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Andrea Curatolo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Current address: Visual Optics and Biophotonics Group, Instituto de Óptica “Daza de Valdés”, Consejo Superior de Investigaciones Cientificas (IO, CSIC), C/Serrano, 121, Madrid 28006, Spain
| | - Philip Wijesinghe
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Current address: SUPA, School of Physics and Astronomy, University of St. Andrews, KY16 9SS, UK
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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17
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Hellerhoff K, Birnbacher L, Sztrókay-Gaul A, Grandl S, Auweter S, Willner M, Marschner M, Mayr D, Reiser MF, Pfeiffer F, Herzen J. Assessment of intraductal carcinoma in situ (DCIS) using grating-based X-ray phase-contrast CT at conventional X-ray sources: An experimental ex-vivo study. PLoS One 2019; 14:e0210291. [PMID: 30625220 PMCID: PMC6326478 DOI: 10.1371/journal.pone.0210291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The extent of intraductal carcinoma in situ (DCIS) is commonly underestimated due to the discontinuous growth and lack of microcalcifications. Specimen radiography has been established to reduce the rate of re-excision. However, the predictive value for margin assessment with conventional specimen radiography for DCIS is low. In this study we assessed the potential of grating-based phase-contrast computed tomography (GBPC-CT) at conventional X-ray sources for specimen tomography of DCIS containing samples. MATERIALS AND METHODS GBPC-CT was performed on four ex-vivo breast specimens containing DCIS and invasive carcinoma of non-specific type. Phase-contrast and absorption-based datasets were manually matched with corresponding histological slices as the standard of reference. RESULTS Matching of CT images and histology was successful. GBPC-CT showed an improved soft tissue contrast compared to absorption-based images revealing more histological details in the same sections. Non-calcifying DCIS exceeding the invasive tumor could be correlated to areas of dilated bright ducts around the tumor. CONCLUSIONS GBPC-CT imaging at conventional X-ray sources offers improved depiction quality for the imaging of breast tissue samples compared to absorption-based imaging, allows the identification of diagnostically relevant tissue details, and provides full three-dimensional assessment of sample margins.
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MESH Headings
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Calcinosis/diagnostic imaging
- Calcinosis/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- In Vitro Techniques
- Mammography/methods
- Microscopy, Phase-Contrast/methods
- Prospective Studies
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Karin Hellerhoff
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Abteilung für Diagnostische Radiologie, Rotkreuzklinikum München, Munich, Germany
| | - Lorenz Birnbacher
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- * E-mail:
| | - Anikó Sztrókay-Gaul
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Abteilung für Diagnostische Radiologie, Rotkreuzklinikum München, Munich, Germany
| | - Susanne Grandl
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Abteilung für Diagnostische Radiologie, Rotkreuzklinikum München, Munich, Germany
| | - Sigrid Auweter
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Marian Willner
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Mathias Marschner
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Doris Mayr
- Institute of Pathology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F. Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
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18
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Allen WM, Wijesinghe P, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Optical palpation for the visualization of tumor in human breast tissue. JOURNAL OF BIOPHOTONICS 2019; 12:e201800180. [PMID: 30054979 DOI: 10.1002/jbio.201800180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/20/2018] [Accepted: 07/26/2018] [Indexed: 05/17/2023]
Abstract
Accurate and effective removal of tumor in one operation is an important goal of breast-conserving surgery. However, it is not always achieved. Surgeons often utilize manual palpation to assess the surgical margin and/or the breast cavity. Manual palpation, however, is subjective and has relatively low resolution. Here, we investigate a tactile imaging technique, optical palpation, for the visualization of tumor. Optical palpation generates maps of the stress at the surface of tissue under static preload compression. Stress is evaluated by measuring the deformation of a contacting thin compliant layer with known mechanical properties using optical coherence tomography. In this study, optical palpation is performed on 34 freshly excised human breast specimens. Wide field-of-view (up to ~46 × 46 mm) stress images, optical palpograms, are presented from four representative specimens, demonstrating the capability of optical palpation to visualize tumor. Median stress reported for adipose tissue, 4 kPa, and benign dense tissue, 8 kPa, is significantly lower than for invasive tumor, 60 kPa. In addition, we demonstrate that optical palpation provides contrast consistent with a related optical technique, quantitative micro-elastography. This study demonstrates that optical palpation holds promise for visualization of tumor in breast-conserving surgery.
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Affiliation(s)
- Wes M Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Philip Wijesinghe
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Benjamin F Dessauvagie
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Christobel M Saunders
- Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Breast Centre, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Brendan F Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
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19
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Smith BL, Gadd MA, Lanahan CR, Rai U, Tang R, Rice-Stitt T, Merrill AL, Strasfeld DB, Ferrer JM, Brachtel EF, Specht MC. Real-time, intraoperative detection of residual breast cancer in lumpectomy cavity walls using a novel cathepsin-activated fluorescent imaging system. Breast Cancer Res Treat 2018; 171:413-420. [PMID: 29948401 DOI: 10.1007/s10549-018-4845-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Obtaining tumor-free surgical margins is critical to prevent recurrence in breast-conserving surgery but it remains challenging. We assessed the LUM Imaging System for real-time, intraoperative detection of residual tumor. METHODS Lumpectomy cavity walls and excised specimens of breast cancer lumpectomy patients were assessed with the LUM Imaging System (Lumicell, Inc., Wellesley MA) with and without intravenous LUM015, a cathepsin-activatable fluorescent agent. Fluorescence at potential sites of residual tumor was evaluated with a sterile hand-held probe, displayed on a monitor and correlated with histopathology. RESULTS Background autofluorescence was assessed in excised specimens from 9 patients who did not receive LUM015. In vivo lumpectomy cavities and excised specimens were then imaged in 15 women undergoing breast cancer surgery who received no LUM015, 0.5, or 1 mg/kg LUM015 (5 women per dose). Among these, 11 patients had invasive carcinoma with ductal carcinoma in situ (DCIS) and 4 had only DCIS. Image acquisition took 1 s for each 2.6-cm-diameter surface. No significant background normal breast fluorescence was identified. Elevated fluorescent signal was seen from invasive cancers and DCIS. Mean tumor-to-normal signal ratios were 4.70 ± 1.23 at 0.5 mg/kg and 4.22 ± 0.9 at 1.0 mg/kg (p = 0.54). Tumor was distinguished from normal tissue in pre-and postmenopausal women and readings were not affected by breast density. Some benign tissues produced fluorescent signal with LUM015. CONCLUSION The LUM Imaging System allows rapid identification of residual tumor in the lumpectomy cavity of breast cancer patients and may reduce rates of positive margins.
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Affiliation(s)
- Barbara L Smith
- Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. .,Massachusetts General Hospital Center for Breast Cancer, Yawkey 9A, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Michele A Gadd
- Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Conor R Lanahan
- Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Upahvan Rai
- Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Rong Tang
- Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Travis Rice-Stitt
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Andrea L Merrill
- Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Jorge M Ferrer
- Lumicell, Inc, 80 William Street #260, Wellesley, 02481, MA, USA
| | - Elena F Brachtel
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michelle C Specht
- Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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20
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Abraham E, Tran B, Roshan D, Graham S, Lehane C, Wykes J, Campbell P, Ebrahimi A. Microscopic positive margins in papillary thyroid cancer do not impact disease recurrence. ANZ J Surg 2018; 88:1193-1197. [PMID: 29701284 DOI: 10.1111/ans.14490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 02/22/2018] [Accepted: 02/24/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prognostic significance of microscopic positive margins in papillary thyroid carcinoma (PTC) remains unclear. The aim of this study was to determine if microscopic positive margins are associated with increased risk of disease recurrence. METHODS This is a retrospective analysis of 610 patients with PTC using multivariate Cox regression to evaluate the association between microscopic positive margins and disease-free survival. RESULTS Microscopic positive margins were found in 67 (11%) patients and associated with extrathyroidal extension (P < 0.001), multifocality (P < 0.001), nodal metastases (P < 0.001), lymphovascular invasion (P < 0.001), age ≥55 years (P = 0.048), administration of radioactive iodine (RAI) therapy (P = 0.001) and a trend towards larger tumour size (18 versus 15 mm; P = 0.074). After a median follow-up of 3.4 years, there were 83 recurrences. Although involved margins were associated with increased risk of recurrence on univariate analysis (hazard ratio 2.6, 95% confidence interval 1.5-4.6; P = 0.001), there was no association after adjusting for age, nodal metastases, tumour size and extrathyroidal extension on multivariate analysis (hazard ratio 1.5, 95% confidence interval 0.8-2.9; P = 0.242). Similar results were obtained after adjusting for RAI and if margins were analysed as focal versus widely positive. In our study cohort, patients with involved margins generally had other indications for RAI. However, in the nine patients who did not receive RAI, there was no recurrence in the thyroid bed. CONCLUSION Despite a strong association between microscopic positive margins and other adverse prognostic factors in PTC, there is no independent association with disease recurrence on multivariate analysis. Microscopic positive margins are rare (1.1%) in the absence of other indications for RAI.
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Affiliation(s)
- Earl Abraham
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Bryan Tran
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - David Roshan
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Susannah Graham
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Christopher Lehane
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Peter Campbell
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Ardalan Ebrahimi
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
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21
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Reyna C, DeSnyder SM. Intraoperative Margin Assessment in Breast Cancer Management. Surg Oncol Clin N Am 2018; 27:155-165. [DOI: 10.1016/j.soc.2017.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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22
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Radioactive Seed Localization or Wire-guided Localization of Nonpalpable Invasive and In Situ Breast Cancer. Ann Surg 2017; 266:29-35. [DOI: 10.1097/sla.0000000000002101] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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23
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Corsi F, Sorrentino L, Bonzini M, Bossi D, Truffi M, Amadori R, Nebuloni M, Brillat B, Mazzucchelli S. Cavity Shaving Reduces Involved Margins and Reinterventions Without Increasing Costs in Breast-Conserving Surgery: A Propensity Score-Matched Study. Ann Surg Oncol 2017; 24:1516-1524. [DOI: 10.1245/s10434-017-5774-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Krammer J, Price ER, Jochelson MS, Watson E, Murray MP, Schoenberg SO, Morris EA. Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins. Eur Radiol 2017; 27:4812-4818. [PMID: 28567547 DOI: 10.1007/s00330-017-4823-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/28/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. METHODS This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. RESULTS 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. CONCLUSIONS Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. KEY POINTS • Post-operative breast MRI accurately defines residual disease of ≥5 mm. • Surgical cavity sensitivities were high for both invasive carcinoma and DCIS. • Post-surgical changes and very small residual disease (<5 mm) may overlap. • Post-operative breast MRI may help planning an accurate re-resection.
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Affiliation(s)
- Julia Krammer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10021, USA.
| | - Elissa R Price
- Department of Radiology and Biomedical Imaging, Division of Women's Imaging, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA, 94115, USA
| | - Maxine S Jochelson
- Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10021, USA
| | - Elizabeth Watson
- Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10021, USA
| | - Melissa P Murray
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Elizabeth A Morris
- Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10021, USA
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25
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Taylor DB, Bourke AG, Hobbs MM, Dixon G, Phillips M, Saunders CM. Breast localization techniques and margin definitions used by Australian and New Zealand surgeons. ANZ J Surg 2016; 86:744-745. [PMID: 27701839 DOI: 10.1111/ans.13632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/15/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Donna B Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Anita G Bourke
- School of Surgery, University of Western Australia, Perth, Western Australia, Australia.,Breast Clinic, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Max M Hobbs
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Glenys Dixon
- School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Phillips
- Harry Perkins Institute for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Christobel M Saunders
- School of Surgery, University of Western Australia, Perth, Western Australia, Australia
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26
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Bray JP. Soft tissue sarcoma in the dog - part 1: a current review. J Small Anim Pract 2016; 57:510-519. [PMID: 27624929 DOI: 10.1111/jsap.12556] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/07/2016] [Accepted: 08/08/2016] [Indexed: 12/24/2022]
Abstract
Soft tissue sarcomas are derived from tissues of mesenchymal origin. Although local recurrence following surgical resection is the characteristic challenge in their management, 40% dogs with high-grade tumours may also develop metastatic disease, despite successful local control. Soft tissue sarcoma is a complex disease and there are many uncertainties regarding the biology and optimal clinical management. There are currently no diagnostic tests that can reliably predict the amount of surgical margin required for a particular tumour, so there can be a mismatch between treatment and disease. Historically, the tendency has been to always recommend wide excision margins but this is not fully supported by recent evidence. A selection bias for less aggressive soft tissue sarcomas in primary care practice can account for good outcomes that are achieved despite narrow surgical excision margins. On the other hand, inappropriately conservative treatment will adversely affect outcomes for patients with more aggressive disease. This review provides an update on the current understanding of management of canine soft tissue sarcomas.
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Affiliation(s)
- J P Bray
- Veterinary Teaching Hospital, Institute for Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North 4442, New Zealand.
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27
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Escribà JM, Esteban L, Gálvez J, Pla MJ, Melià A, Gil-Gil M, Clèries R, Pareja L, Sanz X, Bustins M, Borrás JM, Ribes J. Reoperations after primary breast conserving surgery in women with invasive breast cancer in Catalonia, Spain: a retrospective study. Clin Transl Oncol 2016; 19:448-456. [PMID: 27624712 DOI: 10.1007/s12094-016-1546-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although complete tumor resection is accepted as the best means to reduce recurrence, reoperations after lumpectomy are a common problem in breast cancer. The aim of this study was to assess the reoperation rates after primary breast conserving surgery in invasive breast cancer cases diagnosed in Catalonia, Spain, between 2005 and 2011 and to identify variations based on patient and tumour characteristics. METHODS Women with invasive incident breast cancer identified from the Patient's Hospital Discharge Database [174.0-174.9 codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as the primary diagnosis] and receiving primary breast conserving surgery were included in the study and were followed up to 3 and 12 months by collecting information about repeat breast cancer surgery. RESULTS Reoperation rates after primary breast conserving surgery decreased from 13.0 % in 2005 to 11.7 % in 2011 at 3 months and from 14.2 % in 2005 to 12.9 % in 2011 at 12 months' follow-up. While breast conservation reoperations saw a slight, non-significant increase in the same period (from 5.7 to 7.3 % at 3 months, and from 6.0 to 7.5 % at 12 months), there was a significant decrease in radical reoperation (from 7.3 to 4.4 % at 3 months and from 8.2 to 5.4 % at 12 months). Overall, additional breast surgeries decreased among younger women. CONCLUSIONS Despite the rise of breast conserving surgery, reoperation rates following initial lumpectomy in Catalonia decreased by 10 % at 3 and 12 months' follow-up, remaining low and almost unchanged. Ultimately, there was also a significant decrease in mastectomies.
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Affiliation(s)
- J M Escribà
- Catalan Cancer Registry, Cancer Planning Directorate, Av. Gran Vía 199-203, L' Hospitalet de Llobregat, 08908, Barcelona, Spain.
- Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, L' Hospitalet de Llobregat, Barcelona, Spain.
| | - L Esteban
- Catalan Cancer Registry, Cancer Planning Directorate, Av. Gran Vía 199-203, L' Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - J Gálvez
- Catalan Cancer Registry, Cancer Planning Directorate, Av. Gran Vía 199-203, L' Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - M J Pla
- Breast Cancer Functional Unit, Catalan Institute of Oncology, L' Hospitalet de Llobregat, Barcelona, Spain
| | - A Melià
- Catalan Cancer Registry, Cancer Planning Directorate, Av. Gran Vía 199-203, L' Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - M Gil-Gil
- Breast Cancer Functional Unit, Catalan Institute of Oncology, L' Hospitalet de Llobregat, Barcelona, Spain
| | - R Clèries
- Catalan Cancer Registry, Cancer Planning Directorate, Av. Gran Vía 199-203, L' Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, L' Hospitalet de Llobregat, Barcelona, Spain
| | - L Pareja
- Catalan Cancer Registry, Cancer Planning Directorate, Av. Gran Vía 199-203, L' Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - X Sanz
- Catalan Cancer Registry, Cancer Planning Directorate, Av. Gran Vía 199-203, L' Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - M Bustins
- Divisió d'Anàlisi de la Demanda i l'Activitat, Department of Health, Generalitat de Catalunya, Catalan Health Service, Barcelona, Spain
| | - J M Borrás
- Catalan Cancer Registry, Cancer Planning Directorate, Av. Gran Vía 199-203, L' Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, L' Hospitalet de Llobregat, Barcelona, Spain
| | - J Ribes
- Catalan Cancer Registry, Cancer Planning Directorate, Av. Gran Vía 199-203, L' Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, L' Hospitalet de Llobregat, Barcelona, Spain
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Laws A, Brar MS, Bouchard-Fortier A, Leong B, Quan ML. Intraoperative Margin Assessment in Wire-Localized Breast-Conserving Surgery for Invasive Cancer: A Population-Level Comparison of Techniques. Ann Surg Oncol 2016; 23:3290-6. [DOI: 10.1245/s10434-016-5401-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/18/2022]
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29
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Positive anterior margins in breast conserving surgery: Does it matter? A systematic review of the literature. Breast 2016; 27:105-8. [DOI: 10.1016/j.breast.2015.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/29/2015] [Accepted: 12/19/2015] [Indexed: 11/20/2022] Open
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30
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Margins in Breast-Conserving Surgery for Early Breast Cancer: How Much is Good Enough? CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0204-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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32
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Youngwirth LM, Adam MA, Scheri RP, Roman SA, Sosa JA. Patients Treated at Low-Volume Centers have Higher Rates of Incomplete Resection and Compromised Outcomes: Analysis of 31,129 Patients with Papillary Thyroid Cancer. Ann Surg Oncol 2015; 23:403-9. [PMID: 26416710 DOI: 10.1245/s10434-015-4867-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Data on the importance of margin status after total thyroidectomy for papillary thyroid cancer (PTC) remain limited. This study sought to identify factors associated with positive margins and to determine the impact of positive margins on survival for patients with PTC. METHODS The National Cancer Data Base (1998-2006) was queried for patients with PTC who had undergone total thyroidectomy. The patients were divided into three groups based on margin status (negative, microscopically positive, and macroscopically positive). Patient demographic, clinical, and pathologic features were evaluated. A binary logistic regression model was developed to identify factors associated with positive margins. A Cox proportional hazards model was developed to identify factors associated with survival. RESULTS Of the 31,129 patients enrolled in the study, 91.3 % had negative margins, 8.1 % had microscopically positive margins, and 0.6 % had macroscopically positive margins. The patients with negative margins were younger and more likely to be female, white, covered by private insurance, and treated at an academic or high-volume center (p < 0.05). They had smaller tumors and were less likely to have advanced-stage disease. After multivariable adjustment, increasing patient age [odds ratio (OR) = 1.02; p < 0.01], government insurance (OR = 1.20; p < 0.01), and no insurance (OR = 1.34; p = 0.01) were associated with positive margins. Reception of surgery at a high-volume facility (OR = 0.72; p < 0.01) was protective. After multivariable adjustment, both microscopically [hazard ratio (HR), 1.49; p < 0.01] and macroscopically positive margins (HR = 2.38; p < 0.01) were associated with compromised survival. CONCLUSIONS Several vulnerable patient populations have a higher risk of incomplete resection after thyroidectomy for PTC. High-risk thyroid cancer patients should be referred to high-volume centers to optimize outcomes.
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Affiliation(s)
| | | | | | | | - Julie A Sosa
- Duke University Medical Center, Durham, NC, USA. .,Duke Cancer Institute and Duke Clinical Research Institute, Duke University School of Medicine, DUMC 2945, Durham, NC, USA.
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33
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O'Kelly Priddy CM, Forte VA, Lang JE. The importance of surgical margins in breast cancer. J Surg Oncol 2015; 113:256-63. [PMID: 26394558 DOI: 10.1002/jso.24047] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 12/22/2022]
Abstract
Achieving negative margins with "no tumor on ink" is an appropriate goal in breast conserving therapy (BCT). Wider margins do not decrease recurrence rates, and re-excision in patients with microscopic positive margins is warranted. Several strategies exist to increase rates of negative margins, including techniques to improve tumor localization, intraoperative assessment of margins and oncoplastic techniques. Negative margins should be the goal of BCT, as this will improve both local control and long-term survival.
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Affiliation(s)
- Colleen M O'Kelly Priddy
- Department of Surgery, Section of Breast Soft Tissue Surgery, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Victoria A Forte
- Department of Medicine, Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Julie E Lang
- Department of Surgery, Section of Breast Soft Tissue Surgery, USC Norris Comprehensive Cancer Center, Los Angeles, California
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34
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Boughey JC, McLaughlin SA. Breast Surgery in 2015: Advances in Recent Years. Ann Surg Oncol 2015; 22:3157-60. [DOI: 10.1245/s10434-015-4752-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Indexed: 11/18/2022]
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35
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Does practice make perfect? Resident experience with breast surgery influences excision adequacy. Am J Surg 2015; 209:547-51. [DOI: 10.1016/j.amjsurg.2014.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/14/2014] [Accepted: 10/17/2014] [Indexed: 11/23/2022]
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36
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Pouw B, de Wit-van der Veen LJ, Stokkel MPM, Loo CE, Vrancken Peeters MJTFD, Valdés Olmos RA. Heading toward radioactive seed localization in non-palpable breast cancer surgery? A meta-analysis. J Surg Oncol 2014; 111:185-91. [PMID: 25195916 DOI: 10.1002/jso.23785] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/18/2014] [Indexed: 01/09/2023]
Abstract
Wire-guided localization is the most commonly used technique for intraoperative localization of non-palpable breast cancer. Radioactive seed localization (RSL) is becoming more popular and seems to be a reliable alternative for intraoperative lesion localization. The purpose of the present meta-analysis was to evaluate the use of RSL. Primary study outcomes were irradicality and re-excision rates. In total 3168 patients were included. The clinical adaptation shows growing confidence in RSL and further growth is expected.
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Affiliation(s)
- Bas Pouw
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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37
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Boughey JC, Dietz J. Providing the Best Care for Patients with Breast Cancer Through Use of the Multidisciplinary Team. Ann Surg Oncol 2014; 21:3163-5. [DOI: 10.1245/s10434-014-3958-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Indexed: 11/18/2022]
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