1
|
Zhang M, Zhang J, Gao Y, Han Z, Guo C. Three-dimensional surgical margin positioning technique versus palpation-guided method for breast-conserving surgery: Feasibility, advantages, and quality of life. Asian J Surg 2024; 47:2606-2612. [PMID: 38548542 DOI: 10.1016/j.asjsur.2024.03.087] [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: 11/20/2023] [Revised: 02/10/2024] [Accepted: 03/06/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The accurate evaluation of surgical margins holds crucial importance in determining the success of breast-conserving surgery (BCS). The aim of this study was to introduce a novel technique for the positioning of surgical margins in BCS while highlighting its advantages. METHODS This study included a cohort of breast cancer patients who underwent BCS. The patients were categorized into two groups: one group underwent BCS with the traditional palpation-guided method, and the other with the 3D-MPT technique. The study assessed and compared the feasibility, advantages, and outcomes in terms of quality of life between the two groups. RESULTS A total of 80 patients were successfully enrolled in the study. No significant differences in clinicopathological features were observed between the two groups. The 3D-MPT technique was found to be feasible and offered several advantages over the palpation-guided method. The utilization of guide wires by experienced radiologists to position the margins before surgery enabled precise and swift specimen removal, resulting in the conservation of valuable time and a reduction in the need for re-excision. Furthermore, the 3D-MPT technique exhibited the potential to enhance cosmetic outcomes and elevate patient satisfaction, particularly in cases with uncertain tumor boundaries detectable by palpation. CONCLUSION The 3D-MPT technique proves to be an effective and safe approach for reducing tumor positivity rates in initial surgical margins, thereby improving the quality of life for patients undergoing breast-conserving surgery in comparison to the conventional method.
Collapse
Affiliation(s)
- Mingliang Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical University, No. 287 Changhuai Road, Bengbu 233003, China.
| | - Jingkang Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical University, No. 287 Changhuai Road, Bengbu 233003, China
| | - Yue Gao
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical University, No. 287 Changhuai Road, Bengbu 233003, China
| | - Zhuoqi Han
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical University, No. 287 Changhuai Road, Bengbu 233003, China
| | - Chenxu Guo
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical University, No. 287 Changhuai Road, Bengbu 233003, China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Bhimani F, Lin S, McEvoy M, Cavalli A, Obaid L, Chen Y, Gupta A, Pastoriza J, Shihabi A, Feldman S. Does Nipple-Ward Positive Margin Contribute to a Higher Rate of Re-Excision Procedures After a Lumpectomy with Pathology-Confirmed Positive Margins? A Retrospective Study. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:41-50. [PMID: 38405107 PMCID: PMC10894517 DOI: 10.2147/bctt.s425863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/10/2023] [Indexed: 02/27/2024]
Abstract
Background Positive margins on lumpectomy specimens are associated with a twofold increased risk of local breast tumor recurrence. Prior literature has demonstrated various techniques and modalities for assessing margin status to reduce re-excision rates. However, there is paucity of literature analyzing which margin contributes to the highest re-excision rates. Therefore, the primary aim of the study was to investigate whether the nipple-ward margins resulted in a higher rate of re-excision in our patient population. Methods A retrospective chart review was performed on patients who had re-excision surgery. Nipple-ward margin was identified by correlating radiological and pathological reports. A cut-off of more than 25% was used to demonstrate correlation between nipple-ward margin and re-excision rate. Results A total of 98 patients' data were analyzed, with 41 (41.8%), 14 (14.3%), 5 (5.1%), and 38 (38.8%) diagnosed with DCIS, IDC, ILC, and mixed pathology on their margins, respectively. Overall, 48% (n=47) of the positive margins were nipple-ward, with 44.7% (n=21) reporting DCIS. Upon stratification, 45 (45.9%) cases were single-margin positive, with 26 (57.8%) being nipple-ward. Furthermore, the remaining 53 (54.1%) patients had multiple positive margins, with 21 (39.6.7%) nipple-ward cases. Conclusion Positive nipple-ward margins significantly contribute to a higher re-excision rate p < 0.001; 48% of re-excision surgeries had positive nipple-ward margins, and 57.8% of positive single-margin cases were nipple-ward. Taking an additional shave during initial lumpectomy decreases re-excision rates. However, planning a lumpectomy procedure with a more elliptical rather than a spherical resection with additional cavity shave (ie, larger volume) in the nipple-ward direction and minimizing the remaining cavity shaves so the total volume resected remains unchanged. Nevertheless, future studies with larger sample sizes are required to bolster our findings.
Collapse
Affiliation(s)
- Fardeen Bhimani
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA
| | - Sophie Lin
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA
| | - Maureen McEvoy
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Liane Obaid
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yu Chen
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA
| | - Anjuli Gupta
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jessica Pastoriza
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Areej Shihabi
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA
| | - Sheldon Feldman
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
4
|
Ferreira HHJ, de Souza CD, Pozzo L, Ribeiro MS, Rostelato MECM. Radioactive Seed Localization for Nonpalpable Breast Lesions: Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:441. [PMID: 38396480 PMCID: PMC10887864 DOI: 10.3390/diagnostics14040441] [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: 11/11/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND This study is a systematic review with meta-analysis comparing radioactive seed localization (RSL) versus radio-guided occult lesion localization (ROLL) and wire-guided localization (WGL) for patients with impalpable breast cancer undergoing breast-conserving surgery and evaluating efficacy, safety, and logistical outcomes. The protocol is registered in PROSPERO with the number CRD42022299726. METHODS A search was conducted in the Embase, Lilacs, Pubmed, Scielo, Web of Science, and clinicaltrials.gov databases, in addition to a manual search in the reference list of relevant articles, for randomized clinical trials and cohort studies. Studies selected were submitted to their own data extraction forms and risk of bias analysis according to the ROB 2 and ROBINS 1 tools. A meta-analysis was performed, considering the random effect model, calculating the relative risk or the mean difference for dichotomous or continuous data, respectively. The quality of the evidence generated was analyzed by outcome according to the GRADE tool. Overall, 46 articles met the inclusion criteria and were included in this systematic review; of these, 4 studies compared RSL and ROLL with a population of 1550 women, and 43 compared RSL and WGL with a population of 19,820 women. RESULTS The results showed that RSL is a superior method to WGL in terms of surgical efficiency in the impalpable breast lesions' intraoperative localization, and it is at least equivalent to ROLL. Regarding security, RSL obtained results equivalent to the already established technique, the WGL. In addition to presenting promising results, RSL has been proven to be superior to WGL and ROLL technologies.
Collapse
Affiliation(s)
| | - Carla Daruich de Souza
- Nuclear and Energy Research Institute (IPEN/CNEN—SP), University of São Paulo (USP), Av. Professor Lineu Prestes 2242, São Paulo 05508-000, SP, Brazil; (H.H.J.F.); (L.P.); (M.S.R.); (M.E.C.M.R.)
| | | | | | | |
Collapse
|
5
|
Rossou C, Alampritis G, Patel B. Reducing re-excision rates in breast conserving surgery with Margin Probe: systematic review. Br J Surg 2024; 111:znad335. [PMID: 37991190 PMCID: PMC10776367 DOI: 10.1093/bjs/znad335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/21/2023] [Accepted: 09/28/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Different intraoperative techniques with varying levels of evidence are available to decrease positive surgical margins during breast conserving surgery. The aim of this review is to assess the effectiveness of the MarginProbe® device as an intraoperative adjunct tool in reducing positive surgical margins, and subsequently exploring the effect on patient re-excision rates. METHODOLOGY A systematic review of the available medical literature was conducted from 2007 to March 2022. A literature search of Cochrane, PubMed and Embase by two independent reviewers reviwers was performed to identify eligible articles looking at the primary outcome of percentage reduction in patient re-excision rates using MarginProbe®. Secondary outcomes analysed were comparison of tissue volume removed, absolute and relative reduction in re-excision rate, cosmetic outcome, as well as MarginProbe® sensitivity and specificity. RESULTS A total of 12 full text articles were identified. An independent samples t-test using a total of 2680 patients found a 54.68 per cent reduction in re-excision rate with the use of MarginProbe®, which was statistically significant with a large effect size (P < 0.001; d = 1.826). Secondary outcomes showed a relatively higher sensitivity of the MarginProbe® device, at the expense of decreased specificity, and no significant impact on cosmesis and volume of breast tissue excised. CONCLUSION MarginProbe® is an effective intraoperative adjunct in breast-conservation surgery that reduces patient re-excision rates, with no adverse effects relating to breast cosmesis or increase in volume of excised tissue.
Collapse
Affiliation(s)
- Chara Rossou
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Georgios Alampritis
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Bijendra Patel
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| |
Collapse
|
6
|
Levy Y, Rempel D, Nguyen M, Yassine A, Sanati-Burns M, Salgia P, Lim B, Butler SL, Berkeley A, Bayram E. The Fusion of Wide Field Optical Coherence Tomography and AI: Advancing Breast Cancer Surgical Margin Visualization. Life (Basel) 2023; 13:2340. [PMID: 38137941 PMCID: PMC10744864 DOI: 10.3390/life13122340] [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: 10/20/2023] [Revised: 11/23/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
This study explores the integration of Wide Field Optical Coherence Tomography (WF-OCT) with an AI-driven clinical decision support system, with the goal of enhancing productivity and decision making in breast cancer surgery margin assessment. A computationally efficient convolutional neural network (CNN)-based binary classifier is developed using 585 WF-OCT margin scans from 151 subjects. The CNN model swiftly identifies suspicious areas within margins with an on-device inference time of approximately 10 ms for a 420 × 2400 image. In independent testing on 155 pathology-confirmed margins, including 31 positive margins from 29 patients, the classifier achieved an AUROC of 0.976, a sensitivity of 0.93, and a specificity of 0.98. At the margin level, the deep learning model accurately identified 96.8% of pathology-positive margins. These results highlight the clinical viability of AI-enhanced margin visualization using WF-OCT in breast cancer surgery and its potential to decrease reoperation rates due to residual tumors.
Collapse
Affiliation(s)
- Yanir Levy
- Perimeter Medical Imaging AI Inc., 555 Richmond St W #511, Toronto, ON M5V 3B1, Canada; (D.R.); (M.S.-B.); (A.B.)
| | - David Rempel
- Perimeter Medical Imaging AI Inc., 555 Richmond St W #511, Toronto, ON M5V 3B1, Canada; (D.R.); (M.S.-B.); (A.B.)
| | - Mark Nguyen
- Perimeter Medical Imaging AI Inc., 8585 N Stemmons Fwy Suite 106N, Dallas, TX 75247, USA; (M.N.); (P.S.); (S.L.B.)
| | - Ali Yassine
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 1A1, Canada;
| | - Maggie Sanati-Burns
- Perimeter Medical Imaging AI Inc., 555 Richmond St W #511, Toronto, ON M5V 3B1, Canada; (D.R.); (M.S.-B.); (A.B.)
| | - Payal Salgia
- Perimeter Medical Imaging AI Inc., 8585 N Stemmons Fwy Suite 106N, Dallas, TX 75247, USA; (M.N.); (P.S.); (S.L.B.)
| | - Bryant Lim
- The Institute of Biomedical Engineering, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 1A1, Canada;
| | - Sarah L. Butler
- Perimeter Medical Imaging AI Inc., 8585 N Stemmons Fwy Suite 106N, Dallas, TX 75247, USA; (M.N.); (P.S.); (S.L.B.)
| | - Andrew Berkeley
- Perimeter Medical Imaging AI Inc., 555 Richmond St W #511, Toronto, ON M5V 3B1, Canada; (D.R.); (M.S.-B.); (A.B.)
| | - Ersin Bayram
- Perimeter Medical Imaging AI Inc., 8585 N Stemmons Fwy Suite 106N, Dallas, TX 75247, USA; (M.N.); (P.S.); (S.L.B.)
| |
Collapse
|
7
|
Lin X, Wang Y, Fang K, Guo Z, Lin N, Li L. The application of nanoparticles in theranostic systems targeting breast cancer stem cells: current progress and future challenges. Stem Cell Res Ther 2023; 14:356. [PMID: 38072976 PMCID: PMC10712155 DOI: 10.1186/s13287-023-03584-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Breast cancer (BC) is one of the diseases with the highest female mortality rates in the world and is closely related to breast cancer stem cells (BCSCs). Conventional breast cancer chemotherapy drugs target noncancer stem cells (non-CSCs), while cancer stem cells (CSCs) can still survive, which is an important reason for breast cancer drug resistance and local recurrence or distant metastasis. How to eradicate BCSCs while killing BCs is the key factor to improve the effect, and it is also an important scientific problem to be solved urgently. Therefore, targeted BCSC therapy has become a research hotspot. Interestingly, the emergence of nanotechnology provides a new idea for targeting BCSCs. This study summarizes the current application status of nanomaterials in targeting BCSCs, and attempts to construct a new type of lipid nanoparticle (LNP) that can target BCSCs through mRNA, providing a new idea for the treatment of BC.
Collapse
Affiliation(s)
- Xinyu Lin
- Oncology Institute, Affiliated Hospital of Jiangnan University, Wuxi, 214062, Jiangsu, China
| | - Ying Wang
- Oncology Institute, Affiliated Hospital of Jiangnan University, Wuxi, 214062, Jiangsu, China
| | - Kai Fang
- Oncology Institute, Affiliated Hospital of Jiangnan University, Wuxi, 214062, Jiangsu, China
| | - Zijian Guo
- Department of Oncological Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214062, Jiangsu, China
| | - Nan Lin
- Qilu Hospital of Shandong University, Shandong, 250000, China
| | - Lihua Li
- Oncology Institute, Affiliated Hospital of Jiangnan University, Wuxi, 214062, Jiangsu, China.
| |
Collapse
|
8
|
Rainu SK, Ramachandran RG, Parameswaran S, Krishnakumar S, Singh N. Advancements in Intraoperative Near-Infrared Fluorescence Imaging for Accurate Tumor Resection: A Promising Technique for Improved Surgical Outcomes and Patient Survival. ACS Biomater Sci Eng 2023; 9:5504-5526. [PMID: 37661342 DOI: 10.1021/acsbiomaterials.3c00828] [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: 09/05/2023]
Abstract
Clear surgical margins for solid tumor resection are essential for preventing cancer recurrence and improving overall patient survival. Complete resection of tumors is often limited by a surgeon's ability to accurately locate malignant tissues and differentiate them from healthy tissue. Therefore, techniques or imaging modalities are required that would ease the identification and resection of tumors by real-time intraoperative visualization of tumors. Although conventional imaging techniques such as positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), or radiography play an essential role in preoperative diagnostics, these cannot be utilized in intraoperative tumor detection due to their large size, high cost, long imaging time, and lack of cancer specificity. The inception of several imaging techniques has paved the way to intraoperative tumor margin detection with a high degree of sensitivity and specificity. Particularly, molecular imaging using near-infrared fluorescence (NIRF) based nanoprobes provides superior imaging quality due to high signal-to-noise ratio, deep penetration to tissues, and low autofluorescence, enabling accurate tumor resection and improved survival rates. In this review, we discuss the recent developments in imaging technologies, specifically focusing on NIRF nanoprobes that aid in highly specific intraoperative surgeries with real-time recognition of tumor margins.
Collapse
Affiliation(s)
- Simran Kaur Rainu
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Remya Girija Ramachandran
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Sowmya Parameswaran
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Subramanian Krishnakumar
- L&T Ocular Pathology Department, Vision Research Foundation, Kamalnayan Bajaj Institute for Research in Vision and Ophthalmology, Chennai 600006, India
| | - Neetu Singh
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
- Biomedical Engineering Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Rabindran B, Corben AD. Wide-field optical coherence tomography for microstructural analysis of key tissue types: a proof-of-concept evaluation. Pathol Oncol Res 2023; 29:1611167. [PMID: 37521364 PMCID: PMC10374948 DOI: 10.3389/pore.2023.1611167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
Introduction: The presence of positive margins following tumor resection is a frequent cause of re-excision surgery. Nondestructive, real-time intraoperative histopathological imaging methods may improve margin status assessment at the time of surgery; optical coherence tomography (OCT) has been identified as a potential solution but has not been tested with the most common tissue types in surgical oncology using a single, standardized platform. Methods: This was a proof-of-concept evaluation of a novel device that employs wide-field OCT (WF-OCT; OTIS 2.0 System) to image tissue specimens. Various cadaveric tissues were obtained from a single autopsy and were imaged with WF-OCT then processed for permanent histology. The quality and resolution of the WF-OCT images were evaluated and compared to histology and with images in previous literature. Results: A total of 30 specimens were collected and tissue-specific microarchitecture consistent with previous literature were identified on both WF-OCT images and histology slides for all specimens, and corresponding sections were correlated. Application of vacuum pressure during scanning did not affect specimen integrity. On average, specimens were scanned at a speed of 10.3 s/cm2 with approximately three features observed per tissue type. Conclusion: The WF-OCT images captured in this study displayed the key features of the most common human tissue types encountered in surgical oncology with utility comparable to histology, confirming the utility of an FDA-cleared imaging platform. With further study, WF-OCT may have the potential to bridge the gap between the immediate information needs of the operating room and the longer timeline inherent to histology workflow.
Collapse
Affiliation(s)
| | - Adriana D. Corben
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, United States
| |
Collapse
|
11
|
Vartanian A, Papas PV, Guarecuco Castillo JE, Sistare M, Masri MM. Ultrasound Guided Intraoperative Wire Localization Under General Anesthesia in Breast-Conserving Surgery. Cureus 2023; 15:e41662. [PMID: 37565099 PMCID: PMC10412144 DOI: 10.7759/cureus.41662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Breast-conserving surgery (BCS) is becoming an increasingly preferred surgical technique for treating breast cancer. For the last several decades, using a preoperative wire placed by a radiologist has been the gold standard to help guide surgeons to excise a suspicious mass. In recent years, there has been an increasing focus on using surgeon-performed intraoperative ultrasound (IOUS) during breast-conserving therapy, suggesting improved cosmetic outcomes and a decreased need for re-excision. However, studies have also highlighted that ultrasound may be uncomfortable for surgeons who have become most familiar with a wire-localization technique. Wire localization and intraoperative ultrasound are valuable tools that can improve the accuracy of tumor localization and reduce the need for re-excision. We present a 45-year-old female with a right breast mass, measuring breast imaging reporting and data system (BIRADS) 4A on preoperative ultrasound. Intraoperative wire-localization was performed by the surgeon utilizing ultrasound guidance. The right breast lesion was successfully excised with negative margins. The patient was discharged home and recovered well. Surgeon-performed intraoperative ultrasound can be combined with surgeon-performed wire localization to reduce the need for re-excision surgery and allow the surgeon to retain the familiarity of utilizing a gold-standard technique. Further research is needed to determine the optimal use of surgeon-performed IOUS and wire-localization, and its impact on long-term outcomes.
Collapse
Affiliation(s)
- Artin Vartanian
- General Surgery, St. George's University School of Medicine, St. George's, GRD
| | - Paraskevi V Papas
- General Surgery, St. George's University School of Medicine, St. George's, GRD
| | | | - Michael Sistare
- General Surgery, Larkin Community Hospital, South Miami, USA
| | | |
Collapse
|
12
|
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]
|
13
|
Savioli F, Morrow ES, Cheung LK, Stallard S, Doughty J, Romics L. Routine four-quadrant cavity shaving at the time of wide local excision for breast cancer reduces re-excision rate. Ann R Coll Surg Engl 2023; 105:56-61. [PMID: 35174724 PMCID: PMC9773244 DOI: 10.1308/rcsann.2021.0285] [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] [Accepted: 10/01/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Breast conservation therapy (BCT) has been shown to have comparable long-term survival outcomes when compared with mastectomy. Clearance of excision margin is one of the mainstays of the surgical treatment, which if not achieved at the first operation of BCT results in the need for subsequent surgery. METHODS This study evaluated the impact of routinely taken cavity shavings on re-excision rates. This retrospective two-centre study describes the use of routine four-quadrant cavity shaving in 449 patients with consecutively treated with wide local excision for invasive cancer or ductal carcinoma in situ. RESULTS The overall incomplete excision rate was 10.6%. Routine cavity shaving prevented the need for re-excision in 84 patients (18.7%) and identified the need for further re-excision in 33 patients (7.3%). Median time from surgery to radiotherapy was 50 days (range 13-209) for non-re-excised patients versus 78 days (range 47-260) for re-excised patients (p<0.001). Median time to chemotherapy (n=75) was 44 days (range 14-106) for non-re-excised patients versus 56 days (range 35-116) for re-excised patients (p=0.017). CONCLUSIONS This study demonstrates that routine cavity shaving decreases re-excision rate in patients treated with wide local excision and prevents delays to adjuvant treatment due to incomplete excision.
Collapse
MESH Headings
- Humans
- Female
- Breast Neoplasms/pathology
- Retrospective Studies
- Mastectomy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Mastectomy, Segmental/methods
- Reoperation
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Recurrence, Local/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/pathology
Collapse
Affiliation(s)
| | | | - LK Cheung
- Swansea Bay University Health Board, UK
| | | | | | | |
Collapse
|
14
|
Clement C, Schops L, Nevelsteen I, Thijssen S, Van Ongeval C, Keupers M, Prevos R, Celis V, Neven P, Han S, Laenen A, Smeets A. Retrospective Cohort Study of Practical Applications of Paramagnetic Seed Localisation in Breast Carcinoma and Other Malignancies. Cancers (Basel) 2022; 14:cancers14246215. [PMID: 36551700 PMCID: PMC9777317 DOI: 10.3390/cancers14246215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Background: Paramagnetic seeds are a safe alternative for the wire-guided localisation of non-palpable breast lesions, but can also be applied for non-breast lesions. This study presents the experience with a paramagnetic seed, MagSeed® (Endomagnetics Ltd., Cambridge, UK, CE-registered and FDA-cleared), in an academic and non-academic breast centre. (2) Methods: Multicentre, retrospective analysis of 374 consecutive patients who underwent surgery after paramagnetic seed localisation (MSL) between 2018 and 2020. Indications for localisation included non-palpable breast lesions (n = 356), lymph nodes (n = 15) or soft tissue lesions (n = 3). The primary outcome was feasibility and the rate of positive section margins. The secondary outcome was predictive factors for positive section margins. (3) Results: The accurate excision of high-risk breast lesions, lymph nodes and soft tissue lesions was seen in 91.07% (n = 56). Positive section margins were observed in 7.86% (n = 25) after breast conserving surgery for invasive or ductal carcinoma in situ (DCIS) (n = 318). Invasive breast cancer associated with DCIS (p = 0.043) and the size of DCIS (p < 0.001) were significantly correlated with the positive section margins. (4) Conclusion: This study confirms the feasibility of MSL, as well as the higher risk for positive margins in cases of breast carcinoma with associated DCIS. Soft tissue lesions and lymph nodes associated with other malignancies, e.g., melanoma, can also be localised with paramagnetic seeds. This offers perspectives for future applications, such as the de-escalation of axillary treatment in breast cancer.
Collapse
Affiliation(s)
- Céline Clement
- Multidisciplinary Breast Centre Department Surgical Oncology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Lieve Schops
- Department Gynaecology, Noorderhart Ziekenhuis Pelt, 3900 Pelt, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre Department Surgical Oncology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Soetkin Thijssen
- Department Gynaecology, Noorderhart Ziekenhuis Pelt, 3900 Pelt, Belgium
| | - Chantal Van Ongeval
- Multidisciplinary Breast Centre Department Radiology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Machteld Keupers
- Multidisciplinary Breast Centre Department Radiology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Renate Prevos
- Multidisciplinary Breast Centre Department Radiology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Valerie Celis
- Multidisciplinary Breast Centre Department Radiology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Sileny Han
- Multidisciplinary Breast Centre Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), 3000 Leuven, Belgium
| | - Ann Smeets
- Multidisciplinary Breast Centre Department Surgical Oncology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
- Correspondence:
| |
Collapse
|
15
|
Automated breast ultrasound (ABUS) for intraoperative margin control on surgical specimens in breast conserving surgery. Arch Gynecol Obstet 2022; 307:1949-1955. [PMID: 36503976 DOI: 10.1007/s00404-022-06837-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/23/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE As breast-conserving surgery (BCS) has become the standard for treatment of early breast cancer, the need for new technologies to improve intraoperative margin assessment has become clear. Close or positive margins during BCS lead to additional surgeries, treatment delay, additional stress for patients and increasing healthcare cost. Automated three-dimensional breast ultrasound (ABUS) systems are meant to overcome the shortcomings of hand-held ultrasound (HHUS). In this study, we investigate the feasibility of ABUS to conduct ultrasound on surgical specimens in breast conserving therapy. METHODS In this monocentric, non-interventional study, specimens of 40 women were examined via ABUS. A construction with isotonic saline solution, gel pads and ABUS membranes was invented by our team to produce images of breast cancer specimens using ABUS. Evaluation of the ABUS images was carried out by two independent physicians trained on ABUS evaluation. RESULTS ABUS was conducted on 40 specimens. 90% of the generated images were of high quality. Measured tumor sizes with ABUS were bigger than measured tumor size with HHUS (mean tumor size 22.9 vs. 18.1 mm, CI 2.38-7.35, p < 0.05). The mean difference between the ABUS tumor size and the pathological tumor size was 1.8 mm (CI - 0.84-4.53, p = 0.17). The mean difference between the HHUS tumor size and the pathological tumor size was 3.2 mm (CI - 5.35 to - 1.03, p = 0.005). CONCLUSION ABUS seems to be a suitable method to conduct specimen ultrasound. Further studies are required to evaluate the accuracy of ABUS for intraoperative margin assessment and possible implementation in clinical work routine.
Collapse
|
16
|
Sandor MF, Schwalbach B, Hofmann V, Istrate SE, Schuller Z, Ionescu E, Heimann S, Ragazzi M, Lux MP. Imaging of lumpectomy surface with large field-of-view confocal laser scanning microscope for intraoperative margin assessment - POLARHIS study. Breast 2022; 66:118-125. [PMID: 36240525 PMCID: PMC9574757 DOI: 10.1016/j.breast.2022.10.003] [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: 06/24/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Breast-conserving surgery (BCS) in case of breast cancer and/or in-situ-carcinoma lesions (DCIS) intends to completely remove breast cancer while saving healthy tissue as much as possible to achieve better aesthetic and psychological outcomes for the patient. Such modality should result in postoperative tumor-free margins of the surgical resection in order to carry on with the next therapeutical steps of the patient care. However, 10-40% of patients undergo more than one procedure to achieve acceptable cancer-negative margins. A 2nd operation or further operation (re-operation) has physical, psychological, and economic consequences. It also delays the administration of adjuvant therapy, and has been associated with an elevated risk of local and distant disease relapse. In addition, a high re-operation rate can have significant economic effects - both for the service provider and for the payer. A more efficient intraoperative assessment of the margin may address these issues. Recently, a large field-of-view confocal laser scanning microscope designed to allow real-time intraoperative margin assessment has arrived on the market - the Histolog Scanner. In this paper, we present the first evaluation of lumpectomy margins assessment with this new device. MATERIALS AND METHODS 40 consecutive patients undergoing BCS with invasive and/or DCIS were included. The whole surface of the surgical specimens was imaged right after the operation using the Histolog Scanner (HLS). The assessment of all the specimen margins was performed intraoperatively according to the standard-of-care of the center which consists of combined ultrasound (IOUS) and/or conventional specimen radiography (CSR), and gross surgical inspection. Margin assessment on HLS images was blindly performed after the surgery by 5 surgeons and one pathologist. The capabilities to correctly determine margin status in HLS images was compared to the final histopathological assessment. Furthermore, the potential reduction of positive-margin and re-operation rates by utilization of the HLS were extrapolated. RESULTS The study population included 7/40 patients with DCIS (17.5%), 17/40 patients with DCIS and invasive ductal cancer (IDC NST) (42.5%), 10/40 patients with IDC NST (25%), 4/40 with invasive lobular cancer (ILC) (10%), and 1/40 patients with a mix of IDC NST, DCIS, and ILC. Clinical routine resulted in 13 patients with positive margins identified by final histopathological assessment, resulting in 12 re-operations (30% re-operation rate). Amongst these 12 patients, 10 had DCIS components involved in their margin, confirming the importance of improving the detection accuracy of this specific lesion. Surgeons, who were given a short familiarization on HLS images, and a pathologist were able to detect positive margins in 4/12 and 7/12 patients (33% and 58%), respectively, that were missed by the intraoperative standard of care. In addition, a retrospective analysis of the HLS images revealed that cancer lesions can be identified in 9/12 (75%) patients with positive margins. CONCLUSION The present study presents that breast cancer can be detected by surgeons and pathologists in HLS images of lumpectomy margins leading to a potential reduction of 30% and 75% of the re-operations. The Histolog Scanner is easily inserted into the clinical workflow and has the potential to improve the intraoperative standard-of-care for the assessment of breast conserving treatments. In addition, it has the potential to increase oncological safety and cosmetics by avoiding subsequent resections and can also have a significant positive economic effect for service providers and cost bearers. The data presented in this study will have to be further confirmed in a prospective phase-III-trial.
Collapse
Affiliation(s)
- Mariana-Felicia Sandor
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise, Paderborn, Women′s Hospital, St. Josefs, Salzkotten, St. Vincenz-Krankenhaus GmbH, Husener Str. 81, 33098, Paderborn, Germany
| | - Beatrice Schwalbach
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise, Paderborn, Women′s Hospital, St. Josefs, Salzkotten, St. Vincenz-Krankenhaus GmbH, Husener Str. 81, 33098, Paderborn, Germany
| | - Viktoria Hofmann
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise, Paderborn, Women′s Hospital, St. Josefs, Salzkotten, St. Vincenz-Krankenhaus GmbH, Husener Str. 81, 33098, Paderborn, Germany
| | - Simona-Elena Istrate
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise, Paderborn, Women′s Hospital, St. Josefs, Salzkotten, St. Vincenz-Krankenhaus GmbH, Husener Str. 81, 33098, Paderborn, Germany
| | - Zlatna Schuller
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise, Paderborn, Women′s Hospital, St. Josefs, Salzkotten, St. Vincenz-Krankenhaus GmbH, Husener Str. 81, 33098, Paderborn, Germany
| | - Elena Ionescu
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise, Paderborn, Women′s Hospital, St. Josefs, Salzkotten, St. Vincenz-Krankenhaus GmbH, Husener Str. 81, 33098, Paderborn, Germany
| | - Sara Heimann
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise, Paderborn, Women′s Hospital, St. Josefs, Salzkotten, St. Vincenz-Krankenhaus GmbH, Husener Str. 81, 33098, Paderborn, Germany
| | - Moira Ragazzi
- Pathology Unit, Azienda USL – IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Michael P. Lux
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise, Paderborn, Women′s Hospital, St. Josefs, Salzkotten, St. Vincenz-Krankenhaus GmbH, Husener Str. 81, 33098, Paderborn, Germany,Corresponding author. Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Husener Str. 81, 33098, Paderborn, Germany.
| |
Collapse
|
17
|
Iwai Y, Prigoff JG, Sun L, Wiechmann L, Taback B, Rao R, Ugras SK. Shaves off the Cavity or Specimen in Lumpectomy for Breast Cancer. J Surg Res 2022; 277:296-302. [DOI: 10.1016/j.jss.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/08/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022]
|
18
|
Kelly KJ. Editorial: Updating the Operative Standards for Cancer Surgery Key Questions. Ann Surg Oncol 2022; 29:6511-6514. [PMID: 35980552 DOI: 10.1245/s10434-022-12417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Kaitlyn J Kelly
- Division of Surgical Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
| |
Collapse
|
19
|
Lee JH, Lee H, Bang YJ, Ryu JM, Lee SK, Yu J, Lee JE, Kim SW, Nam SJ, Chae BJ. Comparison of Recurrence Rate Between Re-Excision With Radiotherapy and Radiotherapy-Only Groups in Surgical Margin Involvement of In Situ Carcinoma. J Breast Cancer 2022; 25:288-295. [PMID: 36031753 PMCID: PMC9411028 DOI: 10.4048/jbc.2022.25.e36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/21/2021] [Accepted: 08/07/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Surgical margin status is a surrogate marker for residual tumors after breast-conserving surgery (BCS). A comparison of ipsilateral breast tumor recurrence (IBTR) rates between re-excision combined with radiotherapy (excision with RTx) and RTx alone, following the confirmation of ductal carcinoma in situ (DCIS) in the resection margin after BCS, has not been reported previously. Therefore, in the present study, the clinical characteristics of DCIS involvement in the surgical resection margin between excision with RTx and RTx alone were investigated, and the IBTR rate was compared. Methods We analyzed 8,473 patients treated with BCS followed by RTx between January 2013 and December 2019. Patients were divided into 2 groups based on surgical resection margin status in permanent pathology, and superficial and deep margins were excluded. Patients who underwent re-excision with DCIS confirmed in the resection margin were identified and the IBTR rate was examined. Results Among 8,473 patients treated with BCS, 494 (5.8%) had positive surgical resection margins. The median follow-up period was 47 months. Among the 494 patients with a positive resection margin, 368 (74.5%) had residual DCIS at the surgical resection margin in the final pathology. Among those with confirmed DCIS at the resection margin, 24 patients (6.5%) were re-excised, and 344 patients (93.5%) underwent RTx after observation. The IBTR rates were 4.2% and 1.2% in the re-excision and observation groups, respectively. IBTR-free survival analysis revealed no significant difference between the excision with RTx and RTx-only groups (p = 0.262). Conclusion The IBTR rate did not differ between the excision with RTx and RTx-only groups when DCIS was confirmed at the resection margins. This suggests that RTx and close observation without re-excision could be an option, even in cases where minimal involvement of DCIS is confirmed on surgical resection.
Collapse
Affiliation(s)
- Jun-Hee Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunjun Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Ju Bang
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
20
|
Stachs A, Bollmann J, Martin A, Stubert J, Reimer T, Gerber B, Hartmann S. Radiopaque tissue transfer and X-ray system versus standard specimen radiography for intraoperative margin assessment in breast-conserving surgery: randomized clinical trial. BJS Open 2022; 6:6659244. [PMID: 35946449 PMCID: PMC9364380 DOI: 10.1093/bjsopen/zrac091] [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: 04/25/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
Abstract
Background Reduction of positive margin rate (PMR) in breast-conserving surgery (BCS) of non-palpable breast cancer remains a challenge. The efficacy of intraoperative specimen radiography (SR) is unclear. This randomized trial evaluated whether the PMR was reduced by the use of devices that allow precise localization of the affected margins. Methods Patients with microcalcification-associated breast cancer undergoing planned BCS were enrolled. Study participants were randomized to receive either SR with radiopaque tissue transfer and X-ray system (KliniTrayTM) or the institutional standard procedure (ISO). In all patients with a radiological margin less than 5 mm, an immediate re-excision was conducted. The primary outcome was the PMR. Risk factors for positive margins and the effect of immediate re-excision on final surgery were secondary analyses. Results Among 122 randomized patients, 5 patients were excluded due to the extent of primary surgery and 117 were available for analysis. Final histopathology revealed a PMR of 31.7 per cent for the KliniTrayTM group and 26.3 per cent for the ISO group (P = 0.127). Independent factors for positive margins were histological tumour size more than 30 mm (adjusted OR (aOR) 10.73; 95 per cent c.i. 3.14 to 36.75; P < 0.001) and specimen size more than 50 mm (aOR 6.65; 95 per cent c.i. 2.00 to 22.08; P = 0.002). Immediate re-excision due to positive SR led to an absolute risk reduction in positive margins of 13.6 per cent (from 42.7 to 29.1 per cent). Conclusion Specimen orientation with a radiopaque tissue transfer and X-ray system did not decrease the PMR in patients with microcalcification-associated breast cancer; however, SR and immediate re-excision proved to be helpful in the reduction of PMR. Registration number DRKS00011527 (https://www.drks.de).
Collapse
Affiliation(s)
- Angrit Stachs
- Multidisciplinary Breast Unit, Department of Radiology, University of Rostock , Rostock , Germany
| | - Julia Bollmann
- Multidisciplinary Breast Unit, Department of Gynaecology and Obstetrics, University of Rostock , Rostock , Germany
| | - Annett Martin
- Multidisciplinary Breast Unit, Department of Gynaecology and Obstetrics, University of Rostock , Rostock , Germany
| | - Johannes Stubert
- Multidisciplinary Breast Unit, Department of Gynaecology and Obstetrics, University of Rostock , Rostock , Germany
| | - Toralf Reimer
- Multidisciplinary Breast Unit, Department of Gynaecology and Obstetrics, University of Rostock , Rostock , Germany
| | - Bernd Gerber
- Multidisciplinary Breast Unit, Department of Gynaecology and Obstetrics, University of Rostock , Rostock , Germany
| | - Steffi Hartmann
- Multidisciplinary Breast Unit, Department of Gynaecology and Obstetrics, University of Rostock , Rostock , Germany
| |
Collapse
|
21
|
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.
Collapse
Affiliation(s)
- Rong Zhao
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jun Xing
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - 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
| |
Collapse
|
22
|
Foo KY, Newman K, Fang Q, Gong P, Ismail HM, Lakhiani DD, Zilkens R, Dessauvagie BF, Latham B, Saunders CM, Chin L, Kennedy BF. Multi-class classification of breast tissue using optical coherence tomography and attenuation imaging combined via deep learning. BIOMEDICAL OPTICS EXPRESS 2022; 13:3380-3400. [PMID: 35781967 PMCID: PMC9208580 DOI: 10.1364/boe.455110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 05/27/2023]
Abstract
We demonstrate a convolutional neural network (CNN) for multi-class breast tissue classification as adipose tissue, benign dense tissue, or malignant tissue, using multi-channel optical coherence tomography (OCT) and attenuation images, and a novel Matthews correlation coefficient (MCC)-based loss function that correlates more strongly with performance metrics than the commonly used cross-entropy loss. We hypothesized that using multi-channel images would increase tumor detection performance compared to using OCT alone. 5,804 images from 29 patients were used to fine-tune a pre-trained ResNet-18 network. Adding attenuation images to OCT images yields statistically significant improvements in several performance metrics, including benign dense tissue sensitivity (68.0% versus 59.6%), malignant tissue positive predictive value (PPV) (79.4% versus 75.5%), and total accuracy (85.4% versus 83.3%), indicating that the additional contrast from attenuation imaging is most beneficial for distinguishing between benign dense tissue and malignant tissue.
Collapse
Affiliation(s)
- Ken Y. Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, WA 6009, 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, WA 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, WA 6009, Australia
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, WA 6009, Australia
| | - Peijun Gong
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, WA 6009, 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, WA 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, WA 6009, 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, WA 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, WA 6009, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, and Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia
- Division of Surgery, Medical School, The University of Western Australia, Perth, WA 6009, Australia
| | - Benjamin F. Dessauvagie
- Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, Perth, WA 6009, Australia
- PathWest, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia
| | - Christobel M. Saunders
- Division of Surgery, Medical School, The University of Western Australia, Perth, WA 6009, Australia
- Breast Centre, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
- Breast Clinic, Royal Perth Hospital, Perth, WA 6000, Australia
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, 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, WA 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, WA 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, WA 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Perth, WA 6009, Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies, Perth, WA 6000, Australia
| |
Collapse
|
23
|
Recent Advances in Intraoperative Lumpectomy Margin Assessment for Breast Cancer. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
24
|
Intraoperative Margin Trials in Breast Cancer. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Purpose of Review
Obtaining negative margins in breast conservation surgery continues to be a challenge. Re-excisions are difficult for patients and expensive for the health systems. This paper reviews the literature on current strategies and intraoperative clinical trials to reduce positive margin rates.
Recent Findings
The best available data demonstrate that intraoperative imaging with ultrasound, intraoperative pathologic assessment such as frozen section, and cavity margins have been the most successful intraoperative strategies to reduce positive margins. Emerging technologies such as optical coherence tomography and fluorescent imaging need further study but may be important adjuncts.
Summary
There are several proven strategies to reduce positive margin rates to < 10%. Surgeons should utilize best available resources within their institutions to produce the best outcomes for their patients.
Collapse
|
25
|
Mohamedahmed AYY, Zaman S, Zafar S, Laroiya I, Iqbal J, Tan MLH, Shetty G. Comparison of surgical and oncological outcomes between oncoplastic breast-conserving surgery versus conventional breast-conserving surgery for treatment of breast cancer: A systematic review and meta-analysis of 31 studies. Surg Oncol 2022; 42:101779. [DOI: 10.1016/j.suronc.2022.101779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/01/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
|
26
|
Amiri SA, Berckel PV, Lai M, Dankelman J, Hendriks BHW. Tissue-mimicking phantom materials with tunable optical properties suitable for assessment of diffuse reflectance spectroscopy during electrosurgery. BIOMEDICAL OPTICS EXPRESS 2022; 13:2616-2643. [PMID: 35774339 PMCID: PMC9203083 DOI: 10.1364/boe.449637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
Emerging intraoperative tumor margin assessment techniques require the development of more complex and reliable organ phantoms to assess the performance of the technique before its translation into the clinic. In this work, electrically conductive tissue-mimicking materials (TMMs) based on fat, water and agar/gelatin were produced with tunable optical properties. The composition of the phantoms allowed for the assessment of tumor margins using diffuse reflectance spectroscopy, as the fat/water ratio served as a discriminating factor between the healthy and malignant tissue. Moreover, the possibility of using polyvinyl alcohol (PVA) or transglutaminase in combination with fat, water and gelatin for developing TMMs was studied. The diffuse spectral response of the developed phantom materials had a good match with the spectral response of porcine muscle and adipose tissue, as well as in vitro human breast tissue. Using the developed recipe, anatomically relevant heterogeneous breast phantoms representing the optical properties of different layers of the human breast were fabricated using 3D-printed molds. These TMMs can be used for further development of phantoms applicable for simulating the realistic breast conserving surgery workflow in order to evaluate the intraoperative optical-based tumor margin assessment techniques during electrosurgery.
Collapse
Affiliation(s)
- Sara Azizian Amiri
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, The Netherlands
| | - Pieter Van Berckel
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, The Netherlands
| | - Marco Lai
- Philips Research, IGT & US Devices and Systems Department, Eindhoven, The Netherlands
- Eindhoven University of Technology (TU/e), Eindhoven, The Netherlands
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, The Netherlands
| | - Benno H. W. Hendriks
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, The Netherlands
- Philips Research, IGT & US Devices and Systems Department, Eindhoven, The Netherlands
| |
Collapse
|
27
|
Kubo A, Tanei T, R Pradipta A, Morimoto K, Fujii M, Sota Y, Miyake T, Kagara N, Shimoda M, Naoi Y, Motoyama Y, Morii E, Tanaka K, Shimazu K. Comparison of “click-to-sense” assay with frozen section analysis using simulated surgical margins in breast cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1520-1526. [DOI: 10.1016/j.ejso.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/18/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
|
28
|
Paul K, Razmi S, Pockaj BA, Ladani L, Stromer J. Finite Element Modeling of Quantitative Ultrasound Analysis of the Surgical Margin of Breast Tumor. Tomography 2022; 8:570-584. [PMID: 35314624 PMCID: PMC8938815 DOI: 10.3390/tomography8020047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Ultrasound is commonly used as an imaging tool in the medical sector. Compared to standard ultrasound imaging, quantitative ultrasound analysis can provide more details about a material microstructure. In this study, quantitative ultrasound analysis was conducted through computational modeling to detect various breast duct pathologies in the surgical margin tissue. Both pulse-echo and pitch-catch methods were evaluated for a high-frequency (22–41 MHz) ultrasound analysis. The computational surgical margin modeling was based on various conditions of breast ducts, such as normal duct, ductal hyperplasia, DCIS, and calcification. In each model, ultrasound pressure magnitude variation in the frequency spectrum was analyzed through peak density and mean-peak-to-valley distance (MPVD) values. Furthermore, the spectral patterns of all the margin models were compared to extract more pathology-based information. For the pitch-catch mode, only peak density provided a trend in relation to different duct pathologies. For the pulse-echo mode, only the MPVD was able to do that. From the spectral comparison, it was found that overall pressure magnitude, spectral variation, peak pressure magnitude, and corresponding frequency level provided helpful information to differentiate various pathologies in the surgical margin.
Collapse
Affiliation(s)
- Koushik Paul
- School for Engineering of Matter, Transport and Energy, Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ 85281, USA;
- Correspondence:
| | - Samuel Razmi
- EnMed Department, Texas A&M College of Medicine, Houston, TX 77807, USA;
| | | | - Leila Ladani
- School for Engineering of Matter, Transport and Energy, Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ 85281, USA;
| | - Jeremy Stromer
- Survivability Engineering Branch, US Army Engineer Research and Development Center, Vicksburg, MS 39180, USA;
| |
Collapse
|
29
|
Hoffman A, Ashkenazi I. The efficiency of MarginProbe in detecting positive resection margins in epithelial breast cancer following breast conserving surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1498-1502. [PMID: 35219544 DOI: 10.1016/j.ejso.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Up to 30% of patients undergoing lumpectomy for breast cancer are in need for re-excision due to either close or involved margins. We evaluated the yield of Margin Probe© (MP; Dilon Technologies, USA) in a cohort of patients undergoing lumpectomy for both palpable and non-palpable tumors. METHODS Following lumpectomy, margins were evaluated with MP and readings were compared to the lumpectomies' pathological evaluation irrespective of whether additional margins were removed during surgery. Involved margins or the presence of DCIS within 1 mm of the resection margins were considered as positive margins. RESULTS 48 patients with 51 tumors underwent lumpectomy. Thirteen of the 51 lumpectomies had pathological close or involved margins. MP identified 3 out of the 13 positive margins. False-positive readings were recorded in 97 out of 287 margins. The sensitivity, specificity, positive predictive value and negative predictive value were 23.1% (95%CI 5.0% 53.8%), 66.4% (95%CI 60.7%-71.9%), 3% (95%CI 0.6%-8.5%), and 95.1% (95%CI 91.1%-97.6%) respectively. CONCLUSIONS MP cancer detection rate is relatively low while high false-positive rate leads to unnecessary shavings in almost all patients. Evaluation of MP performance should be based on comparing MP read to pathology report.
Collapse
Affiliation(s)
- Aviad Hoffman
- Breast Cancer Clinic, General Surgery Department, Rambam Medical Center, Haaliya Hashnia 8, Haifa, 3109601, Israel.
| | - Itamar Ashkenazi
- Breast Cancer Clinic, General Surgery Department, Rambam Medical Center, Haaliya Hashnia 8, Haifa, 3109601, Israel
| |
Collapse
|
30
|
Citgez B, Yigit B, Bas S. Oncoplastic and Reconstructive Breast Surgery: A Comprehensive Review. Cureus 2022; 14:e21763. [PMID: 35251834 PMCID: PMC8890601 DOI: 10.7759/cureus.21763] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
|
31
|
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
| |
Collapse
|
32
|
Horattas I, Fenton A, Gabra J, Mendiola A, Li F, Namm J, Solomon N, Gass J, Lum S, Murray M, Howard-McNatt M, Dupont E, Levine E, Brown E, Ollila D, Chiba A, Chagpar AB. Does Breast Cancer Subtype Impact Margin Status in Patients Undergoing Partial Mastectomy? Am Surg 2022; 88:1607-1612. [DOI: 10.1177/00031348211069783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Molecular subtype in invasive breast cancer guides systemic therapy. It is unknown whether molecular subtype should also be considered to tailor surgical therapy. The present investigation was designed to evaluate whether breast cancer subtype impacted surgical margins in patients with invasive breast cancer stage I through III undergoing breast-conserving therapy. Methods Data from 2 randomized trials evaluating cavity shave margins (CSM) on margin status in patients undergoing partial mastectomy (PM) were used for this analysis. Patients were included if invasive carcinoma was present in the PM specimen and data for all 3 receptors (ER, PR, and HER2) were known. Patients were classified as luminal if they were ER and/or PR positive; HER2 enriched if they were ER and PR negative but HER2 positive; and TN if they were negative for all 3 receptors. The impact of subtype on the margin status was evaluated at completion of standard PM, prior to randomization to CSM versus no CSM. Non-parametric statistical analyses were performed using SPSS Version 26. Results Molecular subtype was significantly correlated with race ( P = .011), palpability ( P = .007), and grade ( P < .001). Subtype did not correlate with Hispanic ethnicity ( P = .760) or lymphovascular invasion ( P = .756). In this cohort, the overall positive margin rate was 33.7%. This did not vary based on molecular subtype (positive margin rate 33.7% for patients with luminal tumors vs 36.4% for those with TN tumors, P = .425). Discussion Molecular subtype does not predict margin status. Therefore, molecular subtype should not, independent of other factors, influence surgical decision-making.
Collapse
Affiliation(s)
- Ileana Horattas
- Department of Surgery, Cleveland Clinic Akron General, Akon, OH, USA
| | - Andrew Fenton
- Department of Surgery, Cleveland Clinic Akron General, Akon, OH, USA
| | - Joseph Gabra
- Department of Surgery, Cleveland Clinic Akron General, Akon, OH, USA
| | - Amanda Mendiola
- Department of Surgery, Cleveland Clinic Akron General, Akon, OH, USA
| | - Fanyong Li
- Department of Surgery, Yale University, New Haven, CT, USA
| | - Jukes Namm
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Jennifer Gass
- Department of Surgery, Women and Infants Hospital, Providence, RI, USA
| | - Sharon Lum
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Mary Murray
- Department of Surgery, Cleveland Clinic Akron General, Akon, OH, USA
| | | | | | - Edward Levine
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Eric Brown
- Department of Surgery, Beaumont Hospital, Troy, MI, USA
| | - David Ollila
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Akiko Chiba
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | | |
Collapse
|
33
|
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.
Collapse
|
34
|
Does conventional specimen radiography after neoadjuvant chemotherapy of breast cancer help to reduce the rate of second surgeries? Breast Cancer Res Treat 2021; 191:589-598. [PMID: 34878635 PMCID: PMC8831236 DOI: 10.1007/s10549-021-06466-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/04/2021] [Indexed: 12/12/2022]
Abstract
Purpose This is the first study to systematically evaluate the diagnostic accuracy of intraoperative specimen radiography on margin level and its potential to reduce second surgeries in patients treated with neoadjuvant chemotherapy. Methods This retrospective study included 174 cases receiving breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. Conventional specimen radiography (CSR) was performed to assess potential margin infiltration and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. Results 1044 margins were assessed. Of 47 (4.5%) histopathological positive margins, CSR identified 9 correctly (true positive). 38 infiltrated margins were missed (false negative). This resulted in a sensitivity of 19.2%, a specificity of 89.2%, a positive predictive value (PPV) of 7.7%, and a negative predictive value (NPV) of 95.9%. The rate of secondary procedures was reduced from 23 to 16 with a number needed to treat (NNT) of CSR-guided intraoperative re-excisions of 25. In the subgroup of patients with cCR, the prevalence of positive margins was 10/510 (2.0%), PPV was 1.9%, and the NNT was 85. Conclusion Positive margins after NACT are rare and CSR has only a low sensitivity to detect them. Thus, the rate of secondary surgeries cannot be significantly reduced by recommending targeted re-excisions, especially in cases with cCR. In summary, CSR after NACT is inadequate for intraoperative margin assessment but remains useful to document removal of the biopsy site clip.
Collapse
|
35
|
Pradipta AR, Tanaka K. Biofunctional chemistry and reactivity of biogenic acrolein for cancer diagnosis and therapy. Chem Commun (Camb) 2021; 57:9798-9806. [PMID: 34581321 DOI: 10.1039/d1cc03590h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Acrolein holds excellent potential as a biomarker in various oxidative stress-related diseases, including cancer, Alzheimer's, Parkinson's, and inflammatory disorders. Consequently, a direct method to target and visualize acrolein in biological systems might be essential to provide tools for diagnosis and therapeutic purposes. Previously, we discovered 1,3-dipolar cycloaddition between aryl azides and acrolein, which proceeds without a catalyst to give α-diazocarbonyl derivatives. The reaction proceeds with high reactivity and selectivity even under physiological conditions. We have successfully utilized the reaction as a robust method for detecting acrolein generated by cancer cells. This review discusses the utilization of the endogenous acrolein reaction with aryl azide to (1) distinguish breast cancer from normal tissue during breast-conserving surgery and (2) treat cancer through selective prodrug activation in a mouse model without causing adverse effects. The methods have potential clinical application for breast-conserving surgery and are highly advantageous for cancer therapy.
Collapse
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
| | - 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
| |
Collapse
|
36
|
Kong Y, Lyu N, Wang J, Wang Y, Sun Y, Xie Z, Liu P. Does Mammotome biopsy affect surgery option and margin status of breast conserving surgery in breast cancer? Gland Surg 2021; 10:2428-2437. [PMID: 34527554 DOI: 10.21037/gs-20-701] [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: 09/07/2020] [Accepted: 07/02/2021] [Indexed: 12/20/2022]
Abstract
Background The Mammotome, an image-guided, usually ultrasound-guided vacuum-assisted breast biopsy (US-VABB) system, has been widely used in the early diagnosis of breast disease and the complete excision of benign lesions. However, in some malignant lesions underestimated by U.S., whether Mammotome biopsy would affect the surgery option, especially the margin status in breast-conserving surgery (BCS), has never been studied. Methods Between 2015 and 2019, 198 patients with 200 lesions who have been diagnosed with breast cancer by Mammotome elsewhere received surgery by pathological confirmation in our center. The clinicopathological characteristics, surgery options, therapies, and the details of the specimen, such as margin status of BCS, tumor residual after VABB, and hematoma were reviewed. Results Among 200 lesions, 90% were evaluated below US-BIRADS 4b before Mammotome biopsy and 94.5% with a tumor size ≤3 cm. 131 patients received mastectomy (66.2%) and 67 received BCS (33.8%). Hematoma and tumor residual were observed in 37.5% and 71.5% of all lesions, respectively. There is a higher incidence of hematoma in the mastectomy group than in the BCS group (44.4% vs. 23.9%, P=0.005). In BCS group, the positive margin was found in 7 patients at first examination including four focals with re-excision, two extensive with mastectomy and one focal but refusing further surgery. The ultimate success rate of BCS was 95.5%. Margin positivity correlated with tumor residual (P=0.044) but not with hematoma. Conclusions Mammotome biopsy might lead to hematoma and tumor residual; however, it is not the determinant factor for a surgery option, and BCS is feasible through a complete excision of tumor residual to acquire negative margin.
Collapse
Affiliation(s)
- Yanan Kong
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ning Lyu
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianwei Wang
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan Wang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ya Sun
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zeming Xie
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Peng Liu
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
37
|
Choi YJ. Migration of the localization wire to the back in patient with nonpalpable breast carcinoma: A case report. World J Clin Cases 2021; 9:7863-7869. [PMID: 34621839 PMCID: PMC8462241 DOI: 10.12998/wjcc.v9.i26.7863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/19/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Due to the increasing number of diagnosed nonpalpable breast cancer cases, wire localization has been commonly performed for surgical guidance to remove nonpalpable breast lesions. This report presents a rare case of localized wire migration to a subcutaneous lesion of the upper back in a breast cancer patient undergoing breast-conserving surgery.
CASE SUMMARY A 48-year-old female was scheduled for breast-conserving surgery for left breast cancer. Ultrasonography guided wire localization was performed intraoperatively by surgeon to localize the nonpalpable breast cancer. After axilla sentinel lymph node biopsy, we realized that the wire was not visualized. The wire was not found in the operation field, including the breast and axilla. Breast-conserving surgery was performed after wire re-localization. Intraoperative chest posteroanterior view revealed that the wire was located on the level of midaxillary line. Two days after the operation, a serial simple X-ray revealed that the wire was located on the subcutaneous lesion of the back. The wire tip was palpable under the skin of the upper back, and the wire was removed under local anesthesia.
CONCLUSION Hooked wire misplacement can lead to fatal complications. Surgeons must consider the possibility of wire migration during breast cancer surgery.
Collapse
Affiliation(s)
- Young Jin Choi
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
| |
Collapse
|
38
|
Intraoperative fluorescence imaging with aminolevulinic acid detects grossly occult breast cancer: a phase II randomized controlled trial. Breast Cancer Res 2021; 23:72. [PMID: 34253233 PMCID: PMC8276412 DOI: 10.1186/s13058-021-01442-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/25/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Re-excision due to positive margins following breast-conserving surgery (BCS) negatively affects patient outcomes and healthcare costs. The inability to visualize margin involvement is a significant challenge in BCS. 5-Aminolevulinic acid hydrochloride (5-ALA HCl), a non-fluorescent oral prodrug, causes intracellular accumulation of fluorescent porphyrins in cancer cells. This single-center Phase II randomized controlled trial evaluated the safety, feasibility, and diagnostic accuracy of a prototype handheld fluorescence imaging device plus 5-ALA for intraoperative visualization of invasive breast carcinomas during BCS. METHODS Fifty-four patients were enrolled and randomized to receive no 5-ALA or oral 5-ALA HCl (15 or 30 mg/kg). Forty-five patients (n = 15/group) were included in the analysis. Fluorescence imaging of the excised surgical specimen was performed, and biopsies were collected from within and outside the clinically demarcated tumor border of the gross specimen for blinded histopathology. RESULTS In the absence of 5-ALA, tissue autofluorescence imaging lacked tumor-specific fluorescent contrast. Both 5-ALA doses caused bright red tumor fluorescence, with improved visualization of tumor contrasted against normal tissue autofluorescence. In the 15 mg/kg 5-ALA group, the positive predictive value (PPV) for detecting breast cancer inside and outside the grossly demarcated tumor border was 100.0% and 55.6%, respectively. In the 30 mg/kg 5-ALA group, the PPV was 100.0% and 50.0% inside and outside the demarcated tumor border, respectively. No adverse events were observed, and clinical feasibility of this imaging device-5-ALA combination approach was confirmed. CONCLUSIONS This is the first known clinical report of visualization of 5-ALA-induced fluorescence in invasive breast carcinoma using a real-time handheld intraoperative fluorescence imaging device. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT01837225 . Registered 23 April 2013.
Collapse
|
39
|
Mason EE, Mattingly E, Herb K, Śliwiak M, Franconi S, Cooley CZ, Slanetz PJ, Wald LL. Concept for using magnetic particle imaging for intraoperative margin analysis in breast-conserving surgery. Sci Rep 2021; 11:13456. [PMID: 34188077 PMCID: PMC8242088 DOI: 10.1038/s41598-021-92644-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/11/2021] [Indexed: 12/23/2022] Open
Abstract
Breast-conserving surgery (BCS) is a commonly utilized treatment for early stage breast cancers but has relatively high reexcision rates due to post-surgical identification of positive margins. A fast, specific, sensitive, easy-to-use tool for assessing margins intraoperatively could reduce the need for additional surgeries, and while many techniques have been explored, the clinical need is still unmet. We assess the potential of Magnetic Particle Imaging (MPI) for intraoperative margin assessment in BCS, using a passively or actively tumor-targeted iron oxide agent and two hardware devices: a hand-held Magnetic Particle detector for identifying residual tumor in the breast, and a small-bore MPI scanner for quickly imaging the tumor distribution in the excised specimen. Here, we present both hardware systems and demonstrate proof-of-concept detection and imaging of clinically relevant phantoms.
Collapse
Affiliation(s)
- Erica E Mason
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA.
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, 02139, USA.
| | - Eli Mattingly
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, 02139, USA
| | - Konstantin Herb
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Monika Śliwiak
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Sofia Franconi
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Clarissa Zimmerman Cooley
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Priscilla J Slanetz
- Department of Radiology, Boston University Medical Center, Boston, MA, 02118, USA
| | - Lawrence L Wald
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Harvard Medical School, Boston, MA, 02115, USA
| |
Collapse
|
40
|
Clinical practice guidelines for visualized percutaneous breast tissue clips: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021. Chin Med J (Engl) 2021; 134:1768-1770. [PMID: 34091526 PMCID: PMC8367061 DOI: 10.1097/cm9.0000000000001585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
41
|
Resection of Cavity Shave Margins in Stage 0-III Breast Cancer Patients Undergoing Breast Conserving Surgery: A Prospective Multicenter Randomized Controlled Trial. Ann Surg 2021; 273:876-881. [PMID: 31290763 DOI: 10.1097/sla.0000000000003449] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were externally generalizable across practice settings. METHODS In this multicenter randomized controlled trial occurring in 9 centers across the United States, stage 0-III breast cancer patients undergoing PM were randomly assigned to either have resection of CSM ("shave" group) or not ("no shave" group). Randomization occurred intraoperatively, after the surgeon had completed their standard PM. Primary outcome measures were positive margin and re-excision rates. RESULTS Between July 28, 2016 and April 13, 2018, 400 patients were enrolled in this trial. Four patients (2 in each arm) did not meet inclusion criteria after randomization, leaving 396 patients for analysis: 196 in the "shave" group and 200 to the "no shave" group. Median patient age was 65 years (range; 29-94). Groups were well matched at baseline for demographic and clinicopathologic factors. Prior to randomization, positive margin rates were similar in the "shave" and "no shave" groups (76/196 (38.8%) vs. 72/200 (36.0%), respectively, P = 0.604). After randomization, those in the "shave" group were significantly less likely than those in the "no shave" group to have positive margins (19/196 (9.7%) vs. 72/200 (36.0%), P < 0.001), and to require re-excision or mastectomy for margin clearance (17/196 (8.7%) vs. 47/200 (23.5%), P < 0.001). CONCLUSION Resection of CSM significantly reduces positive margin and re-excision rates in patients undergoing PM.
Collapse
|
42
|
Shen JG, Wang LB, Jiang ZN, Yuan XM, Zhao WH, Shen J. Value of intraoperative frozen section analysis in re-excision margin evaluation in breast-conserving surgery for cancer: a single institution experience. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
Jurrius PAGT, Grootendorst MR, Krotewicz M, Cariati M, Kothari A, Patani N, Karcz P, Nagadowska M, Vyas KN, Purushotham A, Turska-d'Amico M. Intraoperative [ 18F]FDG flexible autoradiography for tumour margin assessment in breast-conserving surgery: a first-in-human multicentre feasibility study. EJNMMI Res 2021; 11:28. [PMID: 33738563 PMCID: PMC7973336 DOI: 10.1186/s13550-021-00759-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/05/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction In women undergoing breast-conserving surgery (BCS), 20–25% require a re-operation as a result of incomplete tumour resection. An intra-operative technique to assess tumour margins accurately would be a major advantage. A novel method for intraoperative margin assessment was developed by applying a thin flexible scintillating film to specimens—flexible autoradiography (FAR) imaging. A single-arm, multi-centre study was conducted to evaluate the feasibility of intraoperative [18F]FDG FAR for the assessment of tumour margins in BCS.
Methods Eighty-eight patients with invasive breast cancer undergoing BCS received ≤ 300 MBq of [18F]FDG 60–180 min pre-operatively. Following surgical excision, intraoperative FAR imaging was performed using the LightPath® Imaging System. The first 16 patients were familiarisation patients; the remaining 72 patients were entered into the main study. FAR images were analysed post-operatively by three independent readers. Areas of increased signal intensity were marked, mean normalised radiances and tumour-to-tissue background (TBR) determined, agreement between histopathological margin status and FAR assessed and radiation dose to operating theatre staff measured. Subgroup analyses were performed for various covariates, with thresholds set based on ROC curves. Results Data analysis was performed on 66 patients. Intraoperative margin assessment using FAR was completed on 385 margins with 46.2% sensitivity, 81.7% specificity, 8.1% PPV, 97.7% NPV and an overall accuracy of 80.5%, detecting both invasive carcinoma and DCIS. A subgroup analysis based on [18F]FDG activity present at time of imaging revealed an increased sensitivity (71.4%), PPV (9.3%) and NPV (98.4%) in the high-activity cohort with mean tumour radiance and TBR of 126.7 ± 45.7 photons/s/cm2/sr/MBq and 2.1 ± 0.5, respectively. Staff radiation exposure was low (38.2 ± 38.1 µSv). Conclusion [18F]FDG FAR is a feasible and safe technique for intraoperative tumour margin assessment. Further improvements in diagnostic performance require optimising the method for scintillator positioning and/or the use of targeted radiopharmaceuticals. Trial registration: Identifier: NCT02666079. Date of registration: 28 January 2016. URL: https://clinicaltrials.gov/ct2/show/NCT02666079. ISRCTN registry: Reference: ISRCTN17778965. Date of registration: 11 February 2016. URL: http://www.isrctn.com/ISRCTN17778965.
Collapse
Affiliation(s)
- Patriek A G T Jurrius
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom. .,Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | | | - Marika Krotewicz
- Breast Cancer and Reconstructive Surgery Clinic, Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland
| | - Massimiliano Cariati
- Department of Breast Surgery, University College London Hospital, London, United Kingdom
| | - Ashutosh Kothari
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Neill Patani
- Department of Breast Surgery, University College London Hospital, London, United Kingdom
| | - Paulina Karcz
- Clinical Department of Endocrinology, Maria Skłodowska-Curie Institute of Oncology, Kraków, Poland
| | - Monika Nagadowska
- Breast Cancer and Reconstructive Surgery Clinic, Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland
| | | | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Maria Turska-d'Amico
- Oncological and Reconstructive Surgery Clinic, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice, Poland
| |
Collapse
|
45
|
Vartholomatos G, Ηarissis Η, Andreou M, Tatsi V, Pappa L, Kamina S, Βatistatou A, Markopoulos GS, Alexiou GA. Rapid Assessment of Resection Margins During Breast Conserving Surgery Using Intraoperative Flow Cytometry. Clin Breast Cancer 2021; 21:e602-e610. [PMID: 33820744 DOI: 10.1016/j.clbc.2021.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Positive margins are the most important factor for recurrence of the disease after breast-conserving surgery. Several methods have been developed throughout the years to evaluate the margin status during surgery in an attempt to assist the surgeon in excising the whole tumor at once, a goal that has not yet been accomplished. PATIENTS AND METHODS In our study, we compared intraoperative flow cytometry (iFC) with cytology and pathology in order to evaluate 606 samples of margins and tumors corresponding to 99 patients with invasive ductal carcinoma of no special type and invasive lobular carcinoma obtained from breast-conserving surgeries. RESULTS Using the pathology as the gold standard, flow cytometry had 93.3% sensitivity, 92.4% specificity, and 92.5% accuracy. Cytology had 82.3% sensitivity, 94.6% specificity, and 94.2% accuracy. CONCLUSIONS Our data support the suggestion that iFC is a novel, reliable technique that allows rapid evaluation of the excision margins of lumpectomies, thus improving the precision of breast-conserving surgery. Among the advantages of iFC are that it does not rely on the expertise of a pathologist or cytologist, it is low cost, and it has no additional psychological effect on patients, because no re-operation is needed.
Collapse
Affiliation(s)
- George Vartholomatos
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece; Neurosurgical Institute, University of Ioannina School of Medicine, Ioannina, Greece
| | | | - Maria Andreou
- Haematology Laboratory-Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Lamprini Pappa
- Department of Cytology, University Hospital of Ioannina, Ioannina, Greece
| | - Sevasti Kamina
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Anna Βatistatou
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | | | - George A Alexiou
- Neurosurgical Institute, University of Ioannina School of Medicine, Ioannina, Greece; Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece.
| |
Collapse
|
46
|
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.
Collapse
Affiliation(s)
| | - Kandace McGuire
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | | | | | | | | |
Collapse
|
47
|
Foo KY, Kennedy KM, Zilkens R, Allen WM, Fang Q, Sanderson RW, Anstie J, Dessauvagie BF, Latham B, Saunders CM, Chin L, Kennedy BF. Optical palpation for tumor margin assessment in breast-conserving surgery. BIOMEDICAL OPTICS EXPRESS 2021; 12:1666-1682. [PMID: 33796380 PMCID: PMC7984801 DOI: 10.1364/boe.415888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Intraoperative margin assessment is needed to reduce the re-excision rate of breast-conserving surgery. One possibility is optical palpation, a tactile imaging technique that maps stress (force applied across the tissue surface) as an indicator of tissue stiffness. Images (optical palpograms) are generated by compressing a transparent silicone layer on the tissue and measuring the layer deformation using optical coherence tomography (OCT). This paper reports, for the first time, the diagnostic accuracy of optical palpation in identifying tumor within 1 mm of the excised specimen boundary using an automated classifier. Optical palpograms from 154 regions of interest (ROIs) from 71 excised tumor specimens were obtained. An automated classifier was constructed to predict the ROI margin status by first choosing a circle diameter, then searching for a location within the ROI where the circle was ≥ 75% filled with high stress (indicating a positive margin). A range of circle diameters and stress thresholds, as well as the impact of filtering out non-dense tissue regions, were tested. Sensitivity and specificity were calculated by comparing the automated classifier results with the true margin status, determined from co-registered histology. 83.3% sensitivity and 86.2% specificity were achieved, compared to 69.0% sensitivity and 79.0% specificity obtained with OCT alone on the same dataset using human readers. Representative optical palpograms show that positive margins containing a range of cancer types tend to exhibit higher stress compared to negative margins. These results demonstrate the potential of optical palpation for margin assessment.
Collapse
Affiliation(s)
- Ken Y. Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Kelsey M. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
| | - Wes M. Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Rowan W. Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - James Anstie
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Benjamin F. Dessauvagie
- School of Medicine, The University of Western Australia, Perth, Australia
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Christobel M. Saunders
- School of Medicine, The University of Western Australia, Perth, Australia
- Breast Centre, Fiona Stanley Hospital, Murdoch, Australia
- Breast Clinic, Royal Perth Hospital, Perth, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies, Perth, Australia
| |
Collapse
|
48
|
Montaseri H, Kruger CA, Abrahamse H. Inorganic Nanoparticles Applied for Active Targeted Photodynamic Therapy of Breast Cancer. Pharmaceutics 2021; 13:pharmaceutics13030296. [PMID: 33668307 PMCID: PMC7996317 DOI: 10.3390/pharmaceutics13030296] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
Photodynamic therapy (PDT) is an alternative modality to conventional cancer treatment, whereby a specific wavelength of light is applied to a targeted tumor, which has either a photosensitizer or photochemotherapeutic agent localized within it. This light activates the photosensitizer in the presence of molecular oxygen to produce phototoxic species, which in turn obliterate cancer cells. The incidence rate of breast cancer (BC) is regularly growing among women, which are currently being treated with methods, such as chemotherapy, radiotherapy, and surgery. These conventional treatment methods are invasive and often produce unwanted side effects, whereas PDT is more specific and localized method of cancer treatment. The utilization of nanoparticles in PDT has shown great advantages compared to free photosensitizers in terms of solubility, early degradation, and biodistribution, as well as far more effective intercellular penetration and uptake in targeted cancer cells. This review gives an overview of the use of inorganic nanoparticles (NPs), including: gold, magnetic, carbon-based, ceramic, and up-conversion NPs, as well as quantum dots in PDT over the last 10 years (2009 to 2019), with a particular focus on the active targeting strategies for the PDT treatment of BC.
Collapse
|
49
|
Vaysse PM, Kooreman LFS, Engelen SME, Kremer B, Olde Damink SWM, Heeren RMA, Smidt ML, Porta Siegel T. Stromal vapors for real-time molecular guidance of breast-conserving surgery. Sci Rep 2020; 10:20109. [PMID: 33208813 PMCID: PMC7674429 DOI: 10.1038/s41598-020-77102-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
Achieving radical tumor resection while preserving disease-free tissue during breast-conserving surgery (BCS) remains a challenge. Here, mass spectrometry technologies were used to discriminate stromal tissues reported to be altered surrounding breast tumors, and build tissue classifiers ex vivo. Additionally, we employed the approach for in vivo and real-time classification of breast pathology based on electrosurgical vapors. Breast-resected samples were obtained from patients undergoing surgery at MUMC+. The specimens were subsequently sampled ex vivo to generate electrosurgical vapors analyzed by rapid evaporative ionization mass spectrometry (REIMS). Tissues were processed for histopathology to assign tissue components to the mass spectral profiles. We collected a total of 689 ex vivo REIMS profiles from 72 patients which were analyzed using multivariate statistical analysis (principal component analysis-linear discriminant analysis). These profiles were classified as adipose, stromal and tumor tissues with 92.3% accuracy with a leave-one patient-out cross-validation. Tissue recognition using this ex vivo-built REIMS classification model was subsequently tested in vivo on electrosurgical vapors. Stromal and adipose tissues were classified during one BCS. Complementary ex vivo analyses were performed by REIMS and by desorption electrospray ionization mass spectrometry (DESI-MS) to study the potential of breast stroma to guide BCS. Tumor border stroma (TBS) and remote tumor stroma (RTS) were classified by REIMS and DESI-MS with 86.4% and 87.8% accuracy, respectively. We demonstrate the potential of stromal molecular alterations surrounding breast tumors to guide BCS in real-time using REIMS analysis of electrosurgical vapors.
Collapse
Affiliation(s)
- Pierre-Maxence Vaysse
- Division of Imaging Mass Spectrometry, Maastricht MultiModal Molecular Imaging Institute (M4I), University of Maastricht, Maastricht, The Netherlands.,Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Loes F S Kooreman
- Department of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sanne M E Engelen
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany.,NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, University of Maastricht, Maastricht, The Netherlands
| | - Ron M A Heeren
- Division of Imaging Mass Spectrometry, Maastricht MultiModal Molecular Imaging Institute (M4I), University of Maastricht, Maastricht, The Netherlands
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Tiffany Porta Siegel
- Division of Imaging Mass Spectrometry, Maastricht MultiModal Molecular Imaging Institute (M4I), University of Maastricht, Maastricht, The Netherlands.
| |
Collapse
|
50
|
Lu T, Jorns JM, Patton M, Fisher R, Emmrich A, Doehring T, Schmidt TG, Ye DH, Yen T, Yu B. Rapid assessment of breast tumor margins using deep ultraviolet fluorescence scanning microscopy. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200272R. [PMID: 33241673 PMCID: PMC7688317 DOI: 10.1117/1.jbo.25.12.126501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/28/2020] [Indexed: 06/02/2023]
Abstract
SIGNIFICANCE Re-excision rates for women with invasive breast cancer undergoing breast conserving surgery (or lumpectomy) have decreased in the past decade but remain substantial. This is mainly due to the inability to assess the entire surface of an excised lumpectomy specimen efficiently and accurately during surgery. AIM The goal of this study was to develop a deep-ultraviolet scanning fluorescence microscope (DUV-FSM) that can be used to accurately and rapidly detect cancer cells on the surface of excised breast tissue. APPROACH A DUV-FSM was used to image the surfaces of 47 (31 malignant and 16 normal/benign) fresh breast tissue samples stained in propidium iodide and eosin Y solutions. A set of fluorescence images were obtained from each sample using low magnification (4 × ) and fully automated scanning. The images were stitched to form a color image. Three nonmedical evaluators were trained to interpret and assess the fluorescence images. Nuclear-cytoplasm ratio (N/C) was calculated and used for tissue classification. RESULTS DUV-FSM images a breast sample with subcellular resolution at a speed of 1.0 min / cm2. Fluorescence images show excellent visual contrast in color, tissue texture, cell density, and shape between invasive carcinomas and their normal counterparts. Visual interpretation of fluorescence images by nonmedical evaluators was able to distinguish invasive carcinoma from normal samples with high sensitivity (97.62%) and specificity (92.86%). Using N/C alone was able to differentiate patch-level invasive carcinoma from normal breast tissues with reasonable sensitivity (81.5%) and specificity (78.5%). CONCLUSIONS DUV-FSM achieved a good balance between imaging speed and spatial resolution with excellent contrast, which allows either visual or quantitative detection of invasive cancer cells on the surfaces of a breast surgical specimen.
Collapse
Affiliation(s)
- Tongtong Lu
- Marquette University and Medical College of Wisconsin, Department of Biomedical Engineering, Milwaukee, Wisconsin, United States
| | - Julie M. Jorns
- Medical College of Wisconsin, Department of Pathology, Milwaukee, Wisconsin, United States
| | - Mollie Patton
- Medical College of Wisconsin, Department of Pathology, Milwaukee, Wisconsin, United States
| | - Renee Fisher
- Marquette University and Medical College of Wisconsin, Department of Biomedical Engineering, Milwaukee, Wisconsin, United States
| | - Amanda Emmrich
- Medical College of Wisconsin, Department of Surgery, Milwaukee, Wisconsin, United States
| | | | - Taly Gilat Schmidt
- Marquette University and Medical College of Wisconsin, Department of Biomedical Engineering, Milwaukee, Wisconsin, United States
| | - Dong Hye Ye
- Marquette University, Department of Electrical and Computer Engineering, Milwaukee, Wisconsin, United States
| | - Tina Yen
- Medical College of Wisconsin, Department of Surgery, Milwaukee, Wisconsin, United States
| | - Bing Yu
- Marquette University and Medical College of Wisconsin, Department of Biomedical Engineering, Milwaukee, Wisconsin, United States
| |
Collapse
|