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Guergan S, Boeer B, Fugunt R, Helms G, Roehm C, Solomianik A, Neugebauer A, Nuessle D, Schuermann M, Brunecker K, Jurjut O, Boehme KA, Dammeier S, Enderle MD, Bettio S, Gonzalez-Menendez I, Staebler A, Brucker SY, Kraemer B, Wallwiener D, Fend F, Hahn M. Optical Emission Spectroscopy for the Real-Time Identification of Malignant Breast Tissue. Diagnostics (Basel) 2024; 14:338. [PMID: 38337854 PMCID: PMC10855719 DOI: 10.3390/diagnostics14030338] [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: 11/03/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Breast conserving resection with free margins is the gold standard treatment for early breast cancer recommended by guidelines worldwide. Therefore, reliable discrimination between normal and malignant tissue at the resection margins is essential. In this study, normal and abnormal tissue samples from breast cancer patients were characterized ex vivo by optical emission spectroscopy (OES) based on ionized atoms and molecules generated during electrosurgical treatment. The aim of the study was to determine spectroscopic features which are typical for healthy and neoplastic breast tissue allowing for future real-time tissue differentiation and margin assessment during breast cancer surgery. A total of 972 spectra generated by electrosurgical sparking on normal and abnormal tissue were used for support vector classifier (SVC) training. Specific spectroscopic features were selected for the classification of tissues in the included breast cancer patients. The average classification accuracy for all patients was 96.9%. Normal and abnormal breast tissue could be differentiated with a mean sensitivity of 94.8%, a specificity of 99.0%, a positive predictive value (PPV) of 99.1% and a negative predictive value (NPV) of 96.1%. For 66.6% patients all classifications reached 100%. Based on this convincing data, a future clinical application of OES-based tissue differentiation in breast cancer surgery seems to be feasible.
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Affiliation(s)
- Selin Guergan
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Bettina Boeer
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Regina Fugunt
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Gisela Helms
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Carmen Roehm
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Anna Solomianik
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Alexander Neugebauer
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Daniela Nuessle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Mirjam Schuermann
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Kristin Brunecker
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Ovidiu Jurjut
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Karen A. Boehme
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Sascha Dammeier
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Markus D. Enderle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Sabrina Bettio
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Irene Gonzalez-Menendez
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Annette Staebler
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Sara Y. Brucker
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Bernhard Kraemer
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Diethelm Wallwiener
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Falko Fend
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Markus Hahn
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
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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.
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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
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Hermanns S, Dammeier S, Neugebauer A, Enderle MD. [Methods, applications, and future perspectives of intraoperative tissue identification]. PATHOLOGIE (HEIDELBERG, GERMANY) 2023; 44:183-187. [PMID: 37966557 DOI: 10.1007/s00292-023-01257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
Over the last century, there has been a steady development of new technologies for intraoperative tissue identification and differentiation. The applications are varied, with the core purpose being to identify target structures while preserving adjacent tissue and thereby follow a general paradigm of minimally invasive medicine. Particularly in oncology, a further asset of these technologies is the identification or classification of neoplastic tissue to support and improve therapy, for example, in breast cancer surgery.Many technologies under consideration make use of the different physical characteristics of treated tissues, such as induced fluorescence, optical coherence, and electrical impedance.Recent developments are focusing on moving from ex vivo to in situ and from asynchronous to real-time assistance of the clinicians, for example, by means of optical emission spectroscopy. Refinements of existing and the creation of new methods will include AI tools to make them more powerful while reducing the inter-operator variability in operative interventions. This talk addresses several aspects of the usage and suitability of these technologies for intraoperative, therapy-supporting application.
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Affiliation(s)
- Sanja Hermanns
- Erbe Elektromedizin GmbH, Waldhörnlestr. 17, 72072, Tübingen, Deutschland
| | - Sascha Dammeier
- Erbe Elektromedizin GmbH, Waldhörnlestr. 17, 72072, Tübingen, Deutschland
| | | | - Markus D Enderle
- Erbe Elektromedizin GmbH, Waldhörnlestr. 17, 72072, Tübingen, Deutschland.
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Zhang L, Liao J, Wang H, Zhang M, Liu Y, Jiang C, Han D, Jia Z, Qin C, Niu S, Bu H, Yao J, Liu Y. Near-Infrared II Hyperspectral Imaging Improves the Accuracy of Pathological Sampling of Multiple Cancer Types. J Transl Med 2023; 103:100212. [PMID: 37442199 DOI: 10.1016/j.labinv.2023.100212] [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: 12/17/2022] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Pathological histology is the "gold standard" for clinical diagnosis of cancer. Incomplete or excessive sampling of the formalin-fixed excised cancer specimen will result in inaccurate histologic assessment or excessive workload. Conventionally, pathologists perform specimen sampling relying on naked-eye observation, which is subjective and limited by human perception. Precise identification of cancer tissue, size, and margin is challenging, especially for lesions with inconspicuous tumors. To overcome the limits of human eye perception (visible: 400-700 nm) and improve the sampling efficiency, in this study, we propose using a second near-infrared window (NIR-II: 900-1700 nm) hyperspectral imaging (HSI) system to assist specimen sampling on the strength of the verified deep anatomical penetration and low scattering characteristics of the NIR-II optical window. We used selected NIR-II HSI narrow bands to synthesize color images for human eye observation and also applied a machine learning-based algorithm on the complete NIR-II HSI data for automatic tissue classification to assist pathologists in specimen sampling. A total of 92 tumor samples were collected, including 7 types. Sixty-two (62/92) samples were used as the validation set. Five experienced pathologists marked the contour of the cancer tissue on conventional color images by using different methods, and compared it with the "gold standard," showing that NIR-II HSI-assisted methods had significant improvements in determining cancer tissue compared with conventional methods (conventional color image with or without X-ray). The proposed system can be easily integrated into the current workflow, with high imaging efficiency and no ionizing radiation. It may also find applications in intraoperative detection of residual lesions and identification of different tissues.
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Affiliation(s)
- Lingling Zhang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jun Liao
- AI Lab, Tencent, Shenzhen, Guangdong, China
| | - Han Wang
- AI Lab, Tencent, Shenzhen, Guangdong, China
| | - Meng Zhang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yao Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | | | - Dandan Han
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhanli Jia
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | | | - ShuYao Niu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hong Bu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jianhua Yao
- AI Lab, Tencent, Shenzhen, Guangdong, China.
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Haskell J, Hubbard T, Murray C, Gardner B, Ives C, Ferguson D, Stone N. High wavenumber Raman spectroscopy for intraoperative assessment of breast tumour margins. Analyst 2023; 148:4373-4385. [PMID: 37594446 DOI: 10.1039/d3an00574g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Optimal oncological results and patient outcomes are achieved in surgery for early breast cancer with breast conserving surgery (BCS) where this is appropriate. A limitation of BCS occurs when cancer is present at, or close, to the resection margin - termed a 'positive' margin - and re-excision is recommended to reduce recurrence rate. This is occurs in 17% of BCS in the UK and there is therefore a critical need for a way to assess margin status intraoperatively to ensure complete excision with adequate margins at the first operation. This study presents the potential of high wavenumber (HWN) Raman spectroscopy to address this. Freshly excised specimens from thirty patients undergoing surgery for breast cancer were measured using a surface Raman probe, and a multivariate classification model to predict normal versus tumour was developed from the data. This model achieved 77.1% sensitivity and 90.8% specificity following leave one patient out cross validation, with the defining features being differences in water content and lipid versus protein content. This demonstrates the feasibility of HWN Raman spectroscopy to facilitate future intraoperative margin assessment at specific locations. Clinical utility of the approach will require further research.
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Affiliation(s)
- Jennifer Haskell
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Thomas Hubbard
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Claire Murray
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Benjamin Gardner
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Charlotte Ives
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Douglas Ferguson
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Nick Stone
- Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, Devon, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
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David S, Tran T, Dallaire F, Sheehy G, Azzi F, Trudel D, Tremblay F, Omeroglu A, Leblond F, Meterissian S. In situ Raman spectroscopy and machine learning unveil biomolecular alterations in invasive breast cancer. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:036009. [PMID: 37009577 PMCID: PMC10062385 DOI: 10.1117/1.jbo.28.3.036009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
SIGNIFICANCE As many as 60% of patients with early stage breast cancer undergo breast-conserving surgery. Of those, 20% to 35% need a second surgery because of incomplete resection of the lesions. A technology allowing in situ detection of cancer could reduce re-excision procedure rates and improve patient survival. AIM Raman spectroscopy was used to measure the spectral fingerprint of normal breast and cancer tissue ex-vivo. The aim was to build a machine learning model and to identify the biomolecular bands that allow one to detect invasive breast cancer. APPROACH The system was used to interrogate specimens from 20 patients undergoing lumpectomy, mastectomy, or breast reduction surgery. This resulted in 238 ex-vivo measurements spatially registered with standard histology classifying tissue as cancer, normal, or fat. A technique based on support vector machines led to the development of predictive models, and their performance was quantified using a receiver-operating-characteristic analysis. RESULTS Raman spectroscopy combined with machine learning detected normal breast from ductal or lobular invasive cancer with a sensitivity of 93% and a specificity of 95%. This was achieved using a model based on only two spectral bands, including the peaks associated with C-C stretching of proteins around 940 cm - 1 and the symmetric ring breathing at 1004 cm - 1 associated with phenylalanine. CONCLUSIONS Detection of cancer on the margins of surgically resected breast specimen is feasible with Raman spectroscopy.
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Affiliation(s)
- Sandryne David
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Trang Tran
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Frédérick Dallaire
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Guillaume Sheehy
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Feryel Azzi
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Dominique Trudel
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Institut du cancer de Montréal, Montreal, Quebec, Canada
- Université de Montréal, Department of Pathology and Cellular Biology, Montreal, Quebec, Canada
| | - Francine Tremblay
- McGill University Health Center, Department of Surgery, Montreal, Quebec, Canada
| | - Atilla Omeroglu
- McGill University Health Center, Department of Pathology, Montreal, Quebec, Canada
| | - Frédéric Leblond
- Polytechnique Montréal, Department of Engineering Physics, Montreal, Quebec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Institut du cancer de Montréal, Montreal, Quebec, Canada
| | - Sarkis Meterissian
- McGill University Health Center, Department of Surgery, Montreal, Quebec, Canada
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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.
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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
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Affiliation(s)
| | | | - LK Cheung
- Swansea Bay University Health Board, UK
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Rascevska E, Yip L, Omidi P, Brackstone M, Carson J. Investigating the feasibility of a hand-held photoacoustic imaging probe for margin assessment during breast conserving surgery. PHOTOACOUSTICS 2022; 28:100424. [PMID: 36386296 PMCID: PMC9650058 DOI: 10.1016/j.pacs.2022.100424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Approximately 19 % of breast cancer patients undergoing breast conserving surgery (BCS) must return for a secondary surgery due to incomplete tumour removal. Our previous work demonstrated that the lower lipid content, characteristic of tumour tissue, was observed as regions of hypo-intense photoacoustic (PA) contrast. The goal of this work was to evaluate feasibility of a low-frequency, hand-held PA imaging probe for surgical margin assessment based on lipid content differences. Here, we describe (i) the design of a prototype hand-held PA imaging probe, (ii) the effect of limited-bandwidth on image contrast, (iii) accuracy towards hypo-intense contrast detection, (iv) the limited-view characteristics of the single sensor design, and (iv) early imaging results of an ex-vivo breast cancer specimen. The probe incorporates a single polyvinylidene fluoride acoustic sensor, a 1-to-4 optical fibre bundle and a polycarbonate axicon lens for light delivery. Imaging results on phantoms designed to mimic positive margins demonstrated the ability to detect gaps in optical absorption as small as 1 mm in width. Compared to images from a near full-view PAI system, the hand-held PAI probe had higher signal to noise ratio but suffered from negativity image artifacts. Lumpectomy specimen imaging showed that strong signals can be obtained from the fatty tissue. Taken together, the results show this imaging approach with a hand-held probe has potential for detection of residual breast cancer tissue during BCS; however, more work is needed to reduce the size of the probe to fit within the surgical cavity.
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Affiliation(s)
- E. Rascevska
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor St., London N6A 4V2, ON, Canada
- School of Biomedical Engineering, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
| | - L.C.M. Yip
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor St., London N6A 4V2, ON, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
| | - P. Omidi
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor St., London N6A 4V2, ON, Canada
- School of Biomedical Engineering, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
| | - M. Brackstone
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
- Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond St., N6A 3K7, London, ON, Canada
| | - J.J.L. Carson
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor St., London N6A 4V2, ON, Canada
- School of Biomedical Engineering, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London N6A 3K7, ON, Canada
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Matković A, Kordić A, Jakovčević A, Šarolić A. Complex Permittivity of Ex-Vivo Human, Bovine and Porcine Brain Tissues in the Microwave Frequency Range. Diagnostics (Basel) 2022; 12:2580. [PMID: 36359425 PMCID: PMC9689776 DOI: 10.3390/diagnostics12112580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/20/2022] [Accepted: 10/20/2022] [Indexed: 08/27/2023] Open
Abstract
Accurate knowledge about the dielectric properties of biological tissues in the microwave frequency range may lead to advancement of biomedical applications based on microwave technology. However, the published data are very scarce, especially for human brain tissues. The aim of this work was to measure and report the complex permittivity of brain white matter, grey matter and cerebellum. Complex permittivity was measured on human, bovine and porcine brain tissues in the microwave frequency range from 0.5 to 18 GHz using an open-ended coaxial probe. The results present a valuable addition to the available data on the brain tissue complex permittivity. Some noticeable variations between the results lead to several conclusions. Complex permittivity variation within the same tissue type of the individual species was comparable to interspecies variation. The difference was prominent between human brains obtained from autopsies, while bovine brains obtained from healthy animals showed very similar complex permittivity. We hypothesize that the difference might have been caused by the basic pathologies of the patients, where the associated therapies could have affected the brain water content. We also examined the effect of excised tissue degradation on its complex permittivity over the course of three days, and the results suggest the gradual dehydration of the samples.
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Affiliation(s)
| | - Anton Kordić
- Department of Neurosurgery, University Hospital Centre Zagreb, HR-10000 Zagreb, Croatia
| | - Antonia Jakovčević
- Department of Pathology and Cytology, University Hospital Centre Zagreb, HR-10000 Zagreb, Croatia
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10
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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]
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11
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Qafiti F, Layton C, McDonald KA. Radiofrequency spectroscopy with intraoperative pathological assessment for breast carcinoma: synergistic or redundant? Expert Rev Med Devices 2022; 19:369-373. [PMID: 35531775 DOI: 10.1080/17434440.2022.2075727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Published MarginProbe (Dune Medical Devices Ltd., Israel) data reports ≥50% reduction in positive lumpectomy margins. We sought to determine whether adjunctive use of MarginProbe would provide value over intraoperative pathologic assessment alone. METHODS This is a retrospective chart review of 86 consecutive lumpectomies with MarginProbe from December 2018 to November 2019. Margins were considered positive using 'no ink on tumor' guideline for invasive cancer, and 2 mm or greater for ductal carcinoma in-situ. Significance was measured using Fisher's exact test. RESULTS Seventy-six patients yielded 86 lumpectomies for inclusion. Mean age was 69.8 and mean tumor size was 1.09 cm. Sixty-eight invasive cancers were assessed using adjunct MarginProbe and gross assessment, while 18 ductal carcinoma in-situ cases utilized MarginProbe only. Among all cases, gross assessment alone reduced positive margins(29.2% relative reduction, p = 0.28). Utilizing both modalities, positive margins decreased from 27.9% to 9.3% (66.7% relative reduction, p < 0.01) representing a 46.9% relative reduction versus gross assessment alone. After gross assessment and MarginProbe evaluation, additional excised volume averaged 2.9 cc. CONCLUSIONS Synergistic use of MarginProbe and gross assessment reduces positive margins during breast conserving surgery. Surgeons can weigh its cost against it benefit with the succinct analysis we provide.
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Affiliation(s)
- Fred Qafiti
- Department of Surgery, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Christina Layton
- Department of Surgery, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Kerry-Ann McDonald
- Department of Surgery, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA.,Department of Breast Surgery, Christine E. Lynn Women's Health & Wellness Institute, Boca Raton, FL, USA.,Department of Breast Surgery, Lynn Cancer Institute, Boca Raton, FL, USA
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12
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Miripour ZS, Abbasvandi F, Aghaee P, Shojaeian F, Faramarzpour M, Mohaghegh P, Hoseinpour P, Namdar N, Hassanpour Amiri M, Ghafari H, Parniani M, Kaviani A, Alamdar S, NajafiKhoshnoo S, Sanati H, Mapar M, Sadeghian N, Akbari ME, Yunesian M, Abdolahad M. Human study on cancer diagnostic probe (CDP) for real-time excising of breast positive cavity side margins based on tracing hypoxia glycolysis; checking diagnostic accuracy in non-neoadjuvant cases. Cancer Med 2022; 11:1630-1645. [PMID: 35224879 PMCID: PMC8986141 DOI: 10.1002/cam4.4503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/25/2021] [Accepted: 11/18/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cancer diagnostic probe (CDP) had been developed to detect involved breast cavity side margins in real-time (Miripour et al. Bioeng Transl Med. e10236.). Here, we presented the results of the in vivo human model CDP studies on non-neoadjuvant cases. METHODS This study is a prospective, blind comparison to a gold standard, and the medical group recruited patients. CDP and frozen data were achieved before the permanent pathology experiment. The main outcome of the study is surgical margin status. From November 2018 to April 2020, 202 patients were registered, and 188 were assigned for the study. Breast-conserving surgery at any age or gender, re-surgery due to re-currency, or involved margins are acceptable. Patients must be non-neoadjuvant. The reliability of CDP scoring had been evaluated by the pathology of the scored IMs. Then, three models of the study were designed to compare CDP with the frozen sections. Receiver operating characteristic (ROC) curves and AUC were measured based on the permanent postoperative pathology gold standard. RESULTS A matched clinical diagnostic categorization between the pathological results of the tested IMs and response peaks of CDP on 113 cases, was reported (sensitivity = 97%, specificity = 89.3%, accuracy = 92%, positive predictive value (PPV) = 84.2%, and negative predictive value (NPV) = 98%). Study A showed the independent ability of CDP for IM scoring (sensitivity = 80%, specificity = 90%, accuracy = 90%, PPV = 22.2%, and NPV = 99.2%). Study B showed the complementary role of CDP to cover the missed lesions of frozen sections (sensitivity = 93.8%, specificity = 91%, accuracy = 91%, PPV = 55.6%, and NPV = 99.2%). Study C showed the ability of CDP in helping the pathologist to reduce his/her frozen miss judgment (specificity = 92%, accuracy = 93%, PPV = 42.1%, and NPV = 100%). Results were reported based on the post-surgical permanent pathology gold standard. CONCLUSION CDP scoring ability in intra-operative margin detection was verified on non-neoadjuvant breast cancer patients. Non-invasive real-time diagnosis of IMs with pathological values may make CDP a distinct tool with handheld equipment to increase the prognosis of breast cancer patients.
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Affiliation(s)
- Zohreh Sadat Miripour
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of ExcellenceThin Film and Nanoelectronics LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | - Fereshteh Abbasvandi
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
- ATMP DepartmentBreast Cancer Research CenterMotamed Cancer InstituteACECRTehranIran
- Cancer Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Parisa Aghaee
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of ExcellenceThin Film and Nanoelectronics LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | - Fatemeh Shojaeian
- Cancer Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mahsa Faramarzpour
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of ExcellenceThin Film and Nanoelectronics LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | - Pooneh Mohaghegh
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of ExcellenceThin Film and Nanoelectronics LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | | | - Naser Namdar
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of ExcellenceThin Film and Nanoelectronics LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | - Morteza Hassanpour Amiri
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of ExcellenceThin Film and Nanoelectronics LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | - Hadi Ghafari
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | - Mohammad Parniani
- Pathology DepartmentBreast Cancer Research CenterMotamed Cancer InstituteACECRTehranIran
| | - Ahmad Kaviani
- Institute of CancerImam Khomeini HospitalTehran University of Medical SciencesTehranIran
| | - Sedigheh Alamdar
- Department of PathobiologyIran University of Medical SciencesShahid Hemmat HighwayTehranIran
| | - Sahar NajafiKhoshnoo
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | - Hassan Sanati
- ATMP DepartmentBreast Cancer Research CenterMotamed Cancer InstituteACECRTehranIran
| | - Mahna Mapar
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | - Nastaran Sadeghian
- ATMP DepartmentBreast Cancer Research CenterMotamed Cancer InstituteACECRTehranIran
| | | | - Masud Yunesian
- Department of Environmental HealthSchool of Public HealthTehran University of Medical SciencesTehranIran
- Department of Research Methodology and Data AnalysisInstitute for Environmental ResearchTehran University of Medical SciencesTehranIran
| | - Mohammad Abdolahad
- Nano Bio Electronic Devices LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of ExcellenceThin Film and Nanoelectronics LabSchool of Electrical and Computer EngineeringCollege of EngineeringUniversity of TehranTehranIran
- Institute of CancerImam Khomeini HospitalTehran University of Medical SciencesTehranIran
- UT&TUMS Cancer Electronics Research CenterTehran University of Medical SciencesTehranIran
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13
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Sangha GS, Hu B, Li G, Fox SE, Sholl AB, Brown JQ, Goergen CJ. Assessment of photoacoustic tomography contrast for breast tissue imaging using 3D correlative virtual histology. Sci Rep 2022; 12:2532. [PMID: 35169198 PMCID: PMC8847353 DOI: 10.1038/s41598-022-06501-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/25/2022] [Indexed: 11/12/2022] Open
Abstract
Current breast tumor margin detection methods are destructive, time-consuming, and result in significant reoperative rates. Dual-modality photoacoustic tomography (PAT) and ultrasound has the potential to enhance breast margin characterization by providing clinically relevant compositional information with high sensitivity and tissue penetration. However, quantitative methods that rigorously compare volumetric PAT and ultrasound images with gold-standard histology are lacking, thus limiting clinical validation and translation. Here, we present a quantitative multimodality workflow that uses inverted Selective Plane Illumination Microscopy (iSPIM) to facilitate image co-registration between volumetric PAT-ultrasound datasets with histology in human invasive ductal carcinoma breast tissue samples. Our ultrasound-PAT system consisted of a tunable Nd:YAG laser coupled with a 40 MHz central frequency ultrasound transducer. A linear stepper motor was used to acquire volumetric PAT and ultrasound breast biopsy datasets using 1100 nm light to identify hemoglobin-rich regions and 1210 nm light to identify lipid-rich regions. Our iSPIM system used 488 nm and 647 nm laser excitation combined with Eosin and DRAQ5, a cell-permeant nucleic acid binding dye, to produce high-resolution volumetric datasets comparable to histology. Image thresholding was applied to PAT and iSPIM images to extract, quantify, and topologically visualize breast biopsy lipid, stroma, hemoglobin, and nuclei distribution. Our lipid-weighted PAT and iSPIM images suggest that low lipid regions strongly correlate with malignant breast tissue. Hemoglobin-weighted PAT images, however, correlated poorly with cancerous regions determined by histology and interpreted by a board-certified pathologist. Nuclei-weighted iSPIM images revealed similar cellular content in cancerous and non-cancerous tissues, suggesting malignant cell migration from the breast ducts to the surrounding tissues. We demonstrate the utility of our nondestructive, volumetric, region-based quantitative method for comprehensive validation of 3D tomographic imaging methods suitable for bedside tumor margin detection.
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Affiliation(s)
- Gurneet S Sangha
- Fischell Department of Bioengineering, University of Maryland, 8278 Paint Branch Dr, College Park, MD, 20742, USA.,Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA
| | - Bihe Hu
- Department of Biomedical Engineering, Tulane University, 547 Lindy Boggs Center, New Orleans, LA, 70118, USA
| | - Guang Li
- Department of Biomedical Engineering, Tulane University, 547 Lindy Boggs Center, New Orleans, LA, 70118, USA
| | - Sharon E Fox
- Department of Pathology, LSU Health Sciences Center, New Orleans, 433 Bolivar St, New Orleans, LA, 70112, USA.,Pathology and Laboratory Medicine Service, Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA, 70112, USA
| | - Andrew B Sholl
- Delta Pathology Group, Touro Infirmary, 1401 Foucher St, New Orleans, LA, 70115, USA
| | - J Quincy Brown
- Department of Biomedical Engineering, Tulane University, 547 Lindy Boggs Center, New Orleans, LA, 70118, USA
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA. .,Purdue University Center for Cancer Research, Purdue University, 201 S. University St., West Lafayette, IN, 47907, USA.
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14
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Miripour ZS, Abbasvandi F, Aghaee P, NajafiKhoshnoo S, Faramarzpour M, Mohaghegh P, Hoseinpour P, Namdar N, Amiri MH, Ghafari H, Zareie S, Shojaeian F, Sanati H, Mapar M, Sadeghian N, Akbari ME, Khayamian MA, Abdolahad M. Electrochemical tracing of hypoxia glycolysis by carbon nanotube sensors, a new hallmark for intraoperative detection of suspicious margins to breast neoplasia. Bioeng Transl Med 2022; 7:e10236. [PMID: 35079624 PMCID: PMC8780057 DOI: 10.1002/btm2.10236] [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: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 12/03/2022] Open
Abstract
For most people, the first step in treatment is to take out the tumor (surgery), so precise and fast diagnosis of any sign of high-risk and neoplastic cells, especially in surgical cavity margins, is significant. The frozen pathology method is the conventional standard of intraoperative diagnosis, but the low number of slides prepared from non-fixed tissues prevents us from achieving a perfect diagnosis. Although many improvements in intraoperative margin detection were achieved, still real-time detection of neoplastic lesions is crucial to improving diagnostic quality. Functionalized carbon nanotubes grown on the electrode needles lively and selectively determine the H2O2 released from cancer/atypical cells through reverse Warburg effect and hypoxia assisted glycolysis pathways in a quantitative electrochemical manner. The study was carried out on cell lines, 57 in vivo mice models with breast cancer, and 258 fresh in vitro samples of breast cancer tumors. A real-time electrotechnical system, named cancer diagnostic probe (CDP) (US Patent Pub. No.: US 2018/02991 A1, US 2021/0007638 A1, and US 2021/0022650 A1 [publications], and US 10,786,188 B1 [granted]), has been developed to find pre-neoplastic/neoplastic cells in vivo in a quantitative electrochemical manner by tracing hypoxia glycolysis byproducts. Matched pathological evaluations with response peaks of CDP were found based on the presence of neoplasia (from atypia to invasive carcinoma) in live breast tissues. The ability of CDP to find neoplastic lesions in mice models in vivo and fresh breast tumors in vitro was verified with sensitivity and specificity of 95% and 97%, respectively. The system may help a surgeon assistant system for usage in the operating room after passing many trials and standard examinations in the future.
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Affiliation(s)
- Zohreh Sadat Miripour
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of Excellence, Thin Film and Nanoelectronics Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Fereshteh Abbasvandi
- ATMP DepartmentBreast Cancer Research Center, Motamed Cancer Institute, ACECRTehranIran
| | - Parisa Aghaee
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of Excellence, Thin Film and Nanoelectronics Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Sahar NajafiKhoshnoo
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Mahsa Faramarzpour
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of Excellence, Thin Film and Nanoelectronics Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Pooneh Mohaghegh
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of Excellence, Thin Film and Nanoelectronics Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | | | - Naser Namdar
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of Excellence, Thin Film and Nanoelectronics Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Morteza Hassanpour Amiri
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of Excellence, Thin Film and Nanoelectronics Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Hadi Ghafari
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Sarah Zareie
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of Excellence, Thin Film and Nanoelectronics Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Fatemeh Shojaeian
- Cancer Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Hassan Sanati
- Integrative Oncology DepartmentBreast Cancer Research Center, Motamed Cancer Institute, ACECRTehranIran
| | - Mahna Mapar
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Nastaran Sadeghian
- ATMP DepartmentBreast Cancer Research Center, Motamed Cancer Institute, ACECRTehranIran
| | | | - Mohammad Ali Khayamian
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of Excellence, Thin Film and Nanoelectronics Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
| | - Mohammad Abdolahad
- Nano Bio Electronic Devices Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Nano Electronic Center of Excellence, Thin Film and Nanoelectronics Lab, School of Electrical and Computer Engineering, College of EngineeringUniversity of TehranTehranIran
- Cancer Institute, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
- UT&TUMS Cancer Electrotechnique Research CenterYAS Hospital, Tehran University of Medical SciencesTehranIran
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15
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Dabbagh N, Abbasvandi F, Miripour ZS, Hoseinpour P, Jahanbakhshi F, Moradi A, Riazi H, Moradian F, Zanjani FS, Parniani M, Akbari ME, Abdolahad M. Accuracy of cancer diagnostic probe for intra-surgical checking of cavity side margins in neoadjuvant breast cancer cases: A human model study. Int J Med Robot 2021; 18:e2335. [PMID: 34571582 DOI: 10.1002/rcs.2335] [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: 05/17/2021] [Revised: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Background Recently, a real-time system, named cancer diagnostic probe (CDP), has been developed to diagnose the presence of pre-neoplastic/neoplastic cells in breast cavity side margins. Detecting mechanism is real-time determination of the ROS/H2 O2 released from cancer or atypical cells, through reverse Warburg effect and hypoxia glycolysis pathways. AIMS Here, we designed a human model study based on real-time checking of 387 internal margins (IM) from 39 neoadjuvant breast cancer cases by CDP. MATERIALS & METHODS: Each lesion was checked by entered needle sensor and electrical scores were recorded. The permanent pathology result of each tested lesion was our gold standard to evaluate CDP scoring. CDP results were compared with permanent pathology of tumour side margins (as a conventional margin evaluation procedure). RESULTS Results showed that the sensitivity of CDP in scoring the cavity side margins of those cases is 91%. A total of 18 involved IM which had been detected by CDP were declared as free margins in pathology section of tumour side samples. Just five involved IM were missed by CDP. DISCUSSIONS Such sensitivity revealed that metabolism based (here: hypoxia glycolysis) tracing of cancer cells show distinct electrochemical responses between clear and involved cavity side margin evaluation. CONCLUSION This human study showed the promising role of CDP to achieve clear margins after BCS of neoadjuvant cases.
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Affiliation(s)
- Najmeh Dabbagh
- Nano Bio Electronic Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran.,Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Abbasvandi
- Nano Bio Electronic Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran.,ATMP Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.,SEPAS Pathology Laboratory, Tehran, Iran
| | - Zohreh Sadat Miripour
- Nano Bio Electronic Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Parisa Hoseinpour
- Nano Bio Electronic Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran.,SEPAS Pathology Laboratory, Tehran, Iran
| | - Fahimeh Jahanbakhshi
- ATMP Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Afshin Moradi
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hooman Riazi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Moradian
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Parniani
- SEPAS Pathology Laboratory, Tehran, Iran.,Pathology Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | | | - Mohammad Abdolahad
- Nano Bio Electronic Devices Lab, Cancer Electronics Research Group, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran.,School of Medicine, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.,UT-TUMS Cancer Electronics Research Center, Tehran, Iran
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16
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Yang H, Zhang S, Liu P, Cheng L, Tong F, Liu H, Wang S, Liu M, Wang C, Peng Y, Xie F, Zhou B, Cao Y, Guo J, Zhang Y, Ma Y, Shen D, Xi P, Wang S. Use of high-resolution full-field optical coherence tomography and dynamic cell imaging for rapid intraoperative diagnosis during breast cancer surgery. Cancer 2021; 126 Suppl 16:3847-3856. [PMID: 32710665 DOI: 10.1002/cncr.32838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although traditional intraoperative assessments (ie, frozen sections) may lower reoperation rates in patients with breast cancer, time/tissue limitations and accuracy concerns have discouraged their routine clinical use. Full-field optical coherence tomography (FFOCT) and dynamic cell imaging (DCI) are novel optical imaging techniques offering rapid histologic approximations that are unfettered by requisite handling steps. This study was conducted to determine the feasibility and diagnostic utility of FFOCT and DCI in examining breast and lymph node specimens during breast cancer surgery. METHODS FFOCT and DCI were applied to normal and cancerous breast tissue, benign breast lesions, and resected axillary lymph nodes. The tissues were then subjected to conventional processing and staining (hematoxylin-eosin) for purposes of comparison. RESULTS A total of 314 specimens, including 173 breast biopsies (malignant, 132; benign/normal, 41) and 141 resected lymph nodes (tumor-positive, 48; tumor-negative, 93), were obtained from 158 patients during breast surgery for prospective imaging evaluations. In breast cancer diagnosis, the minimum sensitivities (FFOCT, 85.6%; DCI, 88.6%) and specificities of optical imaging (FFOCT, 85.4%; DCI, 95.1%) were high, although they diverged somewhat in nodal assessments (FFOCT sensitivity, 66.7%; FFOCT specificity, 79.6%; DCI sensitivity, 83.3%; DCI specificity, 98.9%). CONCLUSIONS These timely and tissue-sparing optical imaging techniques proved highly accurate in diagnosing breast cancer and nodal metastasis. They compare favorably with routine histologic sections and demonstrate their promise in this setting.
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Affiliation(s)
- Houpu Yang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Shuwei Zhang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Peng Liu
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Lin Cheng
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Fuzhong Tong
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Hongjun Liu
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Siyuan Wang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Miao Liu
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Chaobin Wang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yuan Peng
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Fei Xie
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Bo Zhou
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yingming Cao
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Jiajia Guo
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yuanyuan Zhang
- Department of Pathology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yingteng Ma
- Department of Pathology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Danhua Shen
- Department of Pathology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Peng Xi
- College of Engineering, Peking University, Beijing, People's Republic of China
| | - Shu Wang
- Breast Center, Peking University People's Hospital, Beijing, People's Republic of China
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17
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Zhu D, Wang J, Marjanovic M, Chaney EJ, Cradock KA, Higham AM, Liu ZG, Gao Z, Boppart SA. Differentiation of breast tissue types for surgical margin assessment using machine learning and polarization-sensitive optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2021; 12:3021-3036. [PMID: 34168912 PMCID: PMC8194620 DOI: 10.1364/boe.423026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 05/04/2023]
Abstract
We report an automated differentiation model for classifying malignant tumor, fibro-adipose, and stroma in human breast tissues based on polarization-sensitive optical coherence tomography (PS-OCT). A total of 720 PS-OCT images from 72 sites of 41 patients with H&E histology-confirmed diagnoses as the gold standard were employed in this study. The differentiation model is trained by the features extracted from both one standard OCT-based metric (i.e., intensity) and four PS-OCT-based metrics (i.e., phase difference between two channels (PD), phase retardation (PR), local phase retardation (LPR), and degree of polarization uniformity (DOPU)). Further optimized by forward searching and validated by leave-one-site-out-cross-validation (LOSOCV) method, the best feature subset was acquired with the highest overall accuracy of 93.5% for the model. Furthermore, to show the superiority of our differentiation model based on PS-OCT images over standard OCT images, the best model trained by intensity-only features (usually obtained by standard OCT systems) was also obtained with an overall accuracy of 82.9%, demonstrating the significance of the polarization information in breast tissue differentiation. The high performance of our differentiation model suggests the potential of using PS-OCT for intraoperative human breast tissue differentiation during the surgical resection of breast cancer.
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Affiliation(s)
- Dan Zhu
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
- These authors contributed equally to this work
| | - Jianfeng Wang
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- These authors contributed equally to this work
| | - Marina Marjanovic
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - Eric J Chaney
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - Kimberly A Cradock
- Department of Surgery, Carle Foundation Hospital, Urbana, Illinois 61801, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois 61801, USA
| | - Anna M Higham
- Department of Surgery, Carle Foundation Hospital, Urbana, Illinois 61801, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois 61801, USA
| | - Zheng G Liu
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois 61801, USA
- Department of Pathology, Carle Foundation Hospital, Urbana, Illinois 61801, USA
| | - Zhishan Gao
- School of Electronic and Optical Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Stephen A Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
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18
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Foo KY, Kennedy KM, Zilkens R, Allen WM, Fang Q, Sanderson RW, Anstie J, Dessauvagie BF, Latham B, Saunders CM, Chin L, Kennedy BF. Optical palpation for tumor margin assessment in breast-conserving surgery. BIOMEDICAL OPTICS EXPRESS 2021; 12:1666-1682. [PMID: 33796380 PMCID: PMC7984801 DOI: 10.1364/boe.415888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Intraoperative margin assessment is needed to reduce the re-excision rate of breast-conserving surgery. One possibility is optical palpation, a tactile imaging technique that maps stress (force applied across the tissue surface) as an indicator of tissue stiffness. Images (optical palpograms) are generated by compressing a transparent silicone layer on the tissue and measuring the layer deformation using optical coherence tomography (OCT). This paper reports, for the first time, the diagnostic accuracy of optical palpation in identifying tumor within 1 mm of the excised specimen boundary using an automated classifier. Optical palpograms from 154 regions of interest (ROIs) from 71 excised tumor specimens were obtained. An automated classifier was constructed to predict the ROI margin status by first choosing a circle diameter, then searching for a location within the ROI where the circle was ≥ 75% filled with high stress (indicating a positive margin). A range of circle diameters and stress thresholds, as well as the impact of filtering out non-dense tissue regions, were tested. Sensitivity and specificity were calculated by comparing the automated classifier results with the true margin status, determined from co-registered histology. 83.3% sensitivity and 86.2% specificity were achieved, compared to 69.0% sensitivity and 79.0% specificity obtained with OCT alone on the same dataset using human readers. Representative optical palpograms show that positive margins containing a range of cancer types tend to exhibit higher stress compared to negative margins. These results demonstrate the potential of optical palpation for margin assessment.
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Affiliation(s)
- Ken Y. Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Kelsey M. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
| | - Wes M. Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Rowan W. Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - James Anstie
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Benjamin F. Dessauvagie
- School of Medicine, The University of Western Australia, Perth, Australia
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Christobel M. Saunders
- School of Medicine, The University of Western Australia, Perth, Australia
- Breast Centre, Fiona Stanley Hospital, Murdoch, Australia
- Breast Clinic, Royal Perth Hospital, Perth, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Australia
- The University of Western Australia, Perth, Australia
- Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, Perth, Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies, Perth, Australia
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19
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Cen C, Chun J, Kaplowitz E, Axelrod D, Shapiro R, Guth A, Schnabel F. Margin Assessment and Re-excision Rates for Patients Who Have Neoadjuvant Chemotherapy and Breast-Conserving Surgery. Ann Surg Oncol 2021; 28:5142-5148. [PMID: 33635409 DOI: 10.1245/s10434-020-09524-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/10/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) has enabled more patients to be eligible for breast-conservation surgery (BCS). Achieving negative lumpectomy margins, however, is challenging due to changes in tissue composition and potentially scattered residual carcinoma in the tumor bed. Data regarding BCS after NAC have shown variable re-excision rates. MarginProbe (Dilon Technologies, Newport News, VA, USA) has been shown to identify positive resection margins intraoperatively and to reduce the number of re-excisions in primary BCS, but has not been studied in NAC+BCS cases. This study aimed to investigate the clinicopathologic characteristics, margin status, and re-excision rates for NAC+BCS patients with and without the use of MarginProbe. METHODS The Institutional Breast Cancer Database was queried for patients who received NAC and had BCS from 2010 to 2019. The variables of interest were demographics, tumor characteristics, pathologic complete response (pCR), MarginProbe use, and re-excision rates. RESULTS The study population consisted of 214 patients who had NAC, 61 (28.5 %) of whom had NAC+BCS. The median age of the patients was 53.5 years. A pCR was achieved for 19 of the patients (31.1 %). Of the remaining 42 patients, 9 (21 %) had close or positive margins that required re-excision. Re-excision was associated with a larger residual tumor size (p = 0.025) and estrogen receptor (ER)-positive disease before NAC (p = 0.041). MarginProbe use was associated with a lower re-excision rate for the patients who had NAC+BCS (6 % vs. 31 %, respectively). CONCLUSION The patients with a larger residual tumor burden and ER-positive disease had a greater risk for inadequate margins at surgery. MarginProbe use was associated with a lower re-excision rate. Techniques to reduce the need for re-excision will support the use of BCS after NAC.
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Affiliation(s)
- Cindy Cen
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Jennifer Chun
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Elianna Kaplowitz
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Deborah Axelrod
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Richard Shapiro
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Amber Guth
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Freya Schnabel
- Department of Surgery, New York University Langone Health, New York, NY, USA.
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20
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Kothari R, Fong Y, Storrie-Lombardi MC. Review of Laser Raman Spectroscopy for Surgical Breast Cancer Detection: Stochastic Backpropagation Neural Networks. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6260. [PMID: 33147836 PMCID: PMC7663399 DOI: 10.3390/s20216260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022]
Abstract
Laser Raman spectroscopy (LRS) is a highly specific biomolecular technique which has been shown to have the ability to distinguish malignant and normal breast tissue. This paper discusses significant advancements in the use of LRS in surgical breast cancer diagnosis, with an emphasis on statistical and machine learning strategies employed for precise, transparent and real-time analysis of Raman spectra. When combined with a variety of "machine learning" techniques LRS has been increasingly employed in oncogenic diagnostics. This paper proposes that the majority of these algorithms fail to provide the two most critical pieces of information required by the practicing surgeon: a probability that the classification of a tissue is correct, and, more importantly, the expected error in that probability. Stochastic backpropagation artificial neural networks inherently provide both pieces of information for each and every tissue site examined by LRS. If the networks are trained using both human experts and an unsupervised classification algorithm as gold standards, rapid progress can be made understanding what additional contextual data is needed to improve network classification performance. Our patients expect us to not simply have an opinion about their tumor, but to know how certain we are that we are correct. Stochastic networks can provide that information.
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Affiliation(s)
- Ragini Kothari
- Department of Surgery, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA;
| | - Yuman Fong
- Department of Surgery, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA;
| | - Michael C. Storrie-Lombardi
- Kinohi Institute, Inc., Santa Barbara, CA 93109, USA;
- Department of Physics, Harvey Mudd College, Claremont, CA 91711, USA
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21
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AND-gate contrast agents for enhanced fluorescence-guided surgery. Nat Biomed Eng 2020; 5:264-277. [PMID: 32989286 PMCID: PMC7969380 DOI: 10.1038/s41551-020-00616-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
The surgical resection of tumours requires the precise location and definition of the margins between lesions and normal tissue. However, this is made difficult by irregular margin borders. Although molecularly targeted optical contrast agents can be used to define tumour margins during surgery in real time, the selectivity of the contrast agents is often limited by the target being expressed in both healthy and tumour tissues. Here, we show that AND-gate optical imaging probes requiring the processing of two substrates by multiple tumour-specific enzymes produce a fluorescent signal with significantly improved specificity and sensitivity to tumour tissue. We evaluated the performance of the probes in mouse models of mammary tumours and of metastatic lung cancer, and during fluorescence-guided robotic surgery. Imaging probes relying on multivariate activation to selectively target complex patterns of enzymatic activity should be useful in disease detection, treatment and monitoring.
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22
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Geha RC, Taback B, Cadena L, Borden B, Feldman S. A Single institution's randomized double-armed prospective study of lumpectomy margins with adjunctive use of the MarginProbe in nonpalpable breast cancers. Breast J 2020; 26:2157-2162. [PMID: 32772474 DOI: 10.1111/tbj.14004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
Breast conservation surgery (BCS) aims to excise all cancerous tissue while minimizing the amount of healthy breast tissue removed. Up to 30% of patients undergoing BCS require a second operation for re-excision to obtain negative margins. Previous studies reported a lower re-excision rate with intraoperative use of the MarginProbe device (Dune Medical Devices). This device utilizes radiofrequency spectroscopy to detect differences between cancerous and normal tissue. From July 2009 to January 2010, our institution enrolled 46 patients electing for BCS in a prospective double-arm randomized controlled trial and had a significantly lower re-excision rate than that reported in the multicenter trial. Intraoperatively, after performing conventional lumpectomy with excision of any additional shavings deemed necessary based on palpation and visual inspection alone, patients were then randomized. In the device arm, the surgeon used the MarginProbe to interrogate the lumpectomy specimen, taking additional shavings from the cavity surfaces corresponding to the parts of the specimen read as positive by the device. In the control arm, only standard intraoperative assessments were performed. All specimens were evaluated by pathologists who were blinded to the study arm. In this population, 72% had invasive ductal carcinoma (IDC), 20% had ductal carcinoma in situ (DCIS), and 8% had invasive lobular carcinoma (ILC). Average age was 64 years old. The average size of the specimen was 5.6 cm, the average volume was 37.8 cm3 , and the average weight was 32.7 g. The mean size of DCIS was 1.4 cm. For invasive specimens, 32 were T1 and 7 were T2. Prior to randomization, 43 patients were thought to have positive or close margins and therefore underwent additional shavings. Twenty-three patients were randomized to the device arm and 23 to the control arm. In the device arm, 14 (60%) patients had IDC, 7 (30%) had DCIS, and 2 (8%) had ILC, vs the control arm where 19 (82%) patients had IDC, 2 (8%) had DCIS, and 2 (8%) had ILC. Eight (35%) patients in the control group vs 1 (4%) in the device group underwent re-excision for margin involvement (P < .05). The use of the MarginProbe device at our institution significantly improved the ability of our surgeons to obtain clear margins during initial BCS. Our results show a lower re-excision rate (4%) than those published in the multicenter trial (19.8%). We postulate that in the face of more patients having DCIS in our device group (30%), our surgeons responded by taking thicker shavings when the MarginProbe device reported margin involvement during the initial lumpectomy, resulting in greater success achieving clear final margins on the shaved tissue and a significantly lower re-excision rate than previously reported with the MarginProbe device.
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Affiliation(s)
- Rula C Geha
- Division of Life Sciences, Mac Andrews and Forbes, Inc, New York, New York, USA
| | - Brett Taback
- Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Lisa Cadena
- Dune Medical Devices, Alpharetta, Georgia, USA
| | - Billie Borden
- Department of Surgery, Northwell Health, Lenox Hill Hospital, New York, New York, USA
| | - Sheldon Feldman
- Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, New York, USA
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23
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Foo KY, Chin L, Zilkens R, Lakhiani DD, Fang Q, Sanderson R, Dessauvagie BF, Latham B, McLaren S, Saunders CM, Kennedy BF. Three-dimensional mapping of the attenuation coefficient in optical coherence tomography to enhance breast tissue microarchitecture contrast. JOURNAL OF BIOPHOTONICS 2020; 13:e201960201. [PMID: 32141243 DOI: 10.1002/jbio.201960201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/16/2020] [Accepted: 03/04/2020] [Indexed: 06/10/2023]
Abstract
Effective intraoperative tumor margin assessment is needed to reduce re-excision rates in breast-conserving surgery (BCS). Mapping the attenuation coefficient in optical coherence tomography (OCT) throughout a sample to create an image (attenuation imaging) is one promising approach. For the first time, three-dimensional OCT attenuation imaging of human breast tissue microarchitecture using a wide-field (up to ~45 × 45 × 3.5 mm) imaging system is demonstrated. Representative results from three mastectomy and one BCS specimen (from 31 specimens) are presented with co-registered postoperative histology. Attenuation imaging is shown to provide substantially improved contrast over OCT, delineating nuanced features within tumors (including necrosis and variations in tumor cell density and growth patterns) and benign features (such as sclerosing adenosis). Additionally, quantitative micro-elastography (QME) images presented alongside OCT and attenuation images show that these techniques provide complementary contrast, suggesting that multimodal imaging could increase tissue identification accuracy and potentially improve tumor margin assessment.
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Affiliation(s)
- Ken Y Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Devina D Lakhiani
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Rowan Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
| | - Benjamin F Dessauvagie
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Sally McLaren
- PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Christobel M Saunders
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
- Breast Centre, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Brendan F Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, Western Australia, Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies, Perth, Western Australia, Australia
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24
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Attia ABE, Balasundaram G, Moothanchery M, Dinish U, Bi R, Ntziachristos V, Olivo M. A review of clinical photoacoustic imaging: Current and future trends. PHOTOACOUSTICS 2019; 16:100144. [PMID: 31871888 PMCID: PMC6911900 DOI: 10.1016/j.pacs.2019.100144] [Citation(s) in RCA: 361] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/05/2019] [Accepted: 08/21/2019] [Indexed: 05/02/2023]
Abstract
Photoacoustic imaging (or optoacoustic imaging) is an upcoming biomedical imaging modality availing the benefits of optical resolution and acoustic depth of penetration. With its capacity to offer structural, functional, molecular and kinetic information making use of either endogenous contrast agents like hemoglobin, lipid, melanin and water or a variety of exogenous contrast agents or both, PAI has demonstrated promising potential in a wide range of preclinical and clinical applications. This review provides an overview of the rapidly expanding clinical applications of photoacoustic imaging including breast imaging, dermatologic imaging, vascular imaging, carotid artery imaging, musculoskeletal imaging, gastrointestinal imaging and adipose tissue imaging and the future directives utilizing different configurations of photoacoustic imaging. Particular emphasis is placed on investigations performed on human or human specimens.
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Key Words
- AR-PAM, acoustic resolution-photoacoustic microscopy
- Clinical applications
- DAQ, data acquisition
- FOV, field-of-view
- Hb, deoxy-hemoglobin
- HbO2, oxy-hemoglobin
- LED, light emitting diode
- MAP, maximum amplitude projection
- MEMS, microelectromechanical systems
- MRI, magnetic resonance imaging
- MSOT, multispectral optoacoustic tomography
- OCT, optical coherence tomography
- OR-PAM, optical resolution-photoacoustic microscopy
- Optoacoustic mesoscopy
- Optoacoustic tomography
- PA, photoacoustic
- PAI, photoacoustic imaging
- PAM, photoacoustic microscopy
- PAT, photoacoustic tomography
- Photoacoustic imaging
- Photoacoustic microscopy
- RSOM, raster-scanning optoacoustic mesoscopy
- SBH-PACT, single breath hold photoacoustic computed tomography system
- US, ultrasound
- sO2, saturation
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Affiliation(s)
| | | | - Mohesh Moothanchery
- Laboratory of Bio-optical Imaging, Singapore Bioimaging Consortium, A*STAR, Singapore
| | - U.S. Dinish
- Laboratory of Bio-optical Imaging, Singapore Bioimaging Consortium, A*STAR, Singapore
| | - Renzhe Bi
- Laboratory of Bio-optical Imaging, Singapore Bioimaging Consortium, A*STAR, Singapore
| | - Vasilis Ntziachristos
- Institute for Biological and Medical Imaging, Technische Universität München and Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Malini Olivo
- Laboratory of Bio-optical Imaging, Singapore Bioimaging Consortium, A*STAR, Singapore
- Corresponding author.
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25
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Schmidt H, Connolly C, Jaffer S, Oza T, Weltz CR, Port ER, Corben A. Evaluation of surgically excised breast tissue microstructure using wide-field optical coherence tomography. Breast J 2019; 26:917-923. [PMID: 31612563 DOI: 10.1111/tbj.13663] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently, positive margins at lumpectomy contribute to health care cost, patient anxiety, and treatment delay. Multiple technology solutions are being explored with the aim of lowering re-excision rates for breast-conserving surgery (BCS). We examined wide-field optical coherence tomography (WF-OCT), an innovative adjunct intraoperative imaging tool for tissue visualization of margins. METHODS This IRB-approved pilot study included women with invasive or in situ carcinoma scheduled for primary BCS. Lumpectomy specimens and any final/revised margins were imaged by optical coherence tomography immediately prior to standard histological processing. The optical coherence tomography used provided two-dimensional, cross-sectional, real-time depth visualization of the margin widths around excised specimens. A volume of images was captured for 10 × 10 cm tissue surface at high resolution (sub-30 μm) to a depth of 2 mm. Integrated interpretation was performed incorporating final pathology linked with the optical image data for correlation. RESULTS Wide-field optical coherence tomography was performed on 185 tissue samples (50 lumpectomy specimens and 135 additional margin shaves) in 50 subjects. Initial diagnosis was invasive ductal carcinoma (IDC) in 10, ductal carcinoma in situ (DCIS) in 14, IDC/DCIS in 22, invasive lobular carcinoma (ILC) in 2, ILC/DCIS in 1, and sarcoma in 1. Optical coherence tomography was concordant with final pathology in 178/185 tissue samples for overall accuracy of 86% and 96.2% (main specimen alone and main specimen + shave margins). Of seven samples that were discordant, 57% (4/7) were considered close (DCIS < 2 mm from margin) per final pathology. CONCLUSION Wide-field optical coherence tomography demonstrated concordance with histology at tissue margins, supporting its potential for use as a real-time adjunct intraoperative imaging tool for margin assessment. Further studies are needed for comprehensive evaluation in the intraoperative setting.
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Affiliation(s)
- Hank Schmidt
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Courtney Connolly
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Shabnam Jaffer
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Twisha Oza
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Christina R Weltz
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Elisa R Port
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
| | - Adriana Corben
- Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, New York
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26
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Zhang B, Ye S, Shankara SB, Zhang H, Zheng Q. Neutral diagnosis: An innovative concept for medical device clinical trials. Contemp Clin Trials Commun 2019; 16:100436. [PMID: 31485547 PMCID: PMC6717093 DOI: 10.1016/j.conctc.2019.100436] [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: 04/04/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022] Open
Abstract
Study design and statistical analysis are crucial in pivotal clinical trials to evaluate the effectiveness and safety of new medical devices under investigation. In recent years, innovative intraoperative in vivo breast tumor diagnostic devices have been proposed to improve the accuracy and surgical outcomes of breast tumor patients undergoing resection. Although such technologies are promising, investigators need to obtain statistical evidence for the effectiveness and safety of these devices by conducting valid clinical trials. However, the study design and statistical analysis for these clinical trials are complicated. While these trials are designed to provide real-time intraoperative diagnosis of cancerous tissue, they also have clear therapeutic objectives to lower the reoperation rate of breast cancer surgery. This research article introduces the new concept of neutral diagnosis (ND), and the ND clinical trial design as an innovative study design to evaluate the effectiveness and safety of diagnostic devices with direct therapeutic purposes. A joint modeling approach is adopted to make inferences on the effectiveness and safety of these devices for non-neutral diagnosis (non-ND) clinical trials. Simulation studies were conducted to show the efficiency of the ND trials and strength of the joint modeling approach in the non-ND clinical trials. An example on a diagnostic medical device that provides real-time, intraoperative diagnosis of breast cancer tumor tissues during breast cancer surgeries is comprehensively discussed and analyzed.
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Affiliation(s)
- Bo Zhang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Shangyuan Ye
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Sravya B Shankara
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - Hui Zhang
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Qingfeng Zheng
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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27
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Kornfeld HW, Mulder LL, Spivey TL, Cortina CS, Madrigrano A, Kopkash KA. The temporal and financial benefit of intraoperative breast specimen imaging: A pilot study of the Kubtec MOZART. Breast J 2019; 25:766-768. [DOI: 10.1111/tbj.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 12/18/2022]
Affiliation(s)
| | - Laurel L. Mulder
- Department of Surgery Rush University Medical Center Chicago Illinois
| | - Tara L. Spivey
- Breast Surgery Service, Division of Surgical Oncology Brigham and Women’s Hospital Boston Massachusetts
| | | | - Andrea Madrigrano
- Division of Surgical Oncology, Department of Surgery Rush University Medical Center Chicago Illinois
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28
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Tang SSK, Rapisarda F, Nerurkar A, Osin P, MacNeill F, Smith I, Johnston S, Ross G, Mohammed K, Gui GPH. Complete excision with narrow margins provides equivalent local control to wider excision in breast conservation for invasive cancer. BJS Open 2018; 3:161-168. [PMID: 30957062 PMCID: PMC6433318 DOI: 10.1002/bjs5.50121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/22/2018] [Indexed: 11/07/2022] Open
Abstract
Background Society of Surgical Oncology and American Society for Radiation Oncology guidelines define clear margins in breast-conserving therapy (BCT) as 'no ink on tumour', in contrast to the attainment of margins of at least 1 mm widely practised in the UK. The primary aim of this study was to explore clinical, surgical and tumour-related factors associated with local recurrence after BCT, with a secondary aim of assessing the impact of margin re-excision on the risk of local recurrence. Methods Patient demographics, surgical details, tumour characteristics and local recurrence were recorded for consecutive women with BCT undergoing surgery between January 1997 and January 2007. Margins were defined as clear (greater than 1 mm), close (less than 1 mm but no ink on tumour), reaches (ink on tumour) and clear after re-excision. Results A total of 1045 women of median age 54 (range 18-86) years were studied. Median follow-up was 89 (range 4-196) months. Local recurrence occurred in 52 patients (5·0 per cent). Ink on tumour was associated with local recurrence (hazard ratio (HR) 4·86, 95 per cent c.i. 1·49 to 15·79; P = 0·009). Risk of local recurrence was the same for close and clear margins (HR 1·03, 0·40 to 2·62; P = 0·954). In women with involved margins, re-excision was still associated with an increased local recurrence risk (HR 2·50, 1·32 to 4·72; P = 0·005). Oestrogen receptor negativity increased risk (HR 2·28, 1·28 to 4·06; P = 0·005). Conclusion Adequately excised margins, even when under 1 mm, provide equivalent outcomes to wider margins in BCT. Achieving complete excision at primary surgery achieves the lowest rates of local recurrence.
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Affiliation(s)
- S S K Tang
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - F Rapisarda
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - A Nerurkar
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - P Osin
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - F MacNeill
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - I Smith
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - S Johnston
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - G Ross
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - K Mohammed
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
| | - G P H Gui
- Academic Breast Unit Royal Marsden Hospital Fulham Road, London SW3 6JJ UK
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29
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Allen WM, Foo KY, Zilkens R, Kennedy KM, Fang Q, Chin L, Dessauvagie BF, Latham B, Saunders CM, Kennedy BF. Clinical feasibility of optical coherence micro-elastography for imaging tumor margins in breast-conserving surgery. BIOMEDICAL OPTICS EXPRESS 2018; 9:6331-6349. [PMID: 31065432 PMCID: PMC6491020 DOI: 10.1364/boe.9.006331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/26/2018] [Accepted: 11/08/2018] [Indexed: 05/08/2023]
Abstract
It has been demonstrated that optical coherence micro-elastography (OCME) provides additional contrast of tumor compared to optical coherence tomography (OCT) alone. Previous studies, however, have predominantly been performed on mastectomy specimens. Such specimens typically differ substantially in composition and geometry from the more clinically relevant wide-local excision (WLE) specimens excised during breast-conserving surgery. As a result, it remains unclear if the mechanical contrast observed is maintained in WLE specimens. In this manuscript, we begin to address this issue by performing a feasibility study of OCME on 17 freshly excised, intact WLE specimens. In addition, we present two developments required to sustain the progression of OCME towards intraoperative deployment. First, to enable the rapid visualization of en face images required for intraoperative assessment, we describe an automated segmentation algorithm to fuse en face micro-elastograms with OCT images to provide dual contrast images. Secondly, to validate contrast in micro-elastograms, we present a method that enables co-registration of en face images with histology of WLE specimens, sectioned in the orthogonal plane, without any modification to the standard clinical workflow. We present a summary of the observations across the 17 specimens imaged in addition to representative micro-elastograms and OCT images demonstrating contrast in a number of tumor margins, including those involved by invasive ductal carcinoma, mucinous carcinoma, and solid-papillary carcinoma. The results presented here demonstrate the potential of OCME for imaging tumor margins.
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Affiliation(s)
- Wes M. Allen
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Ken Y. Foo
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Renate Zilkens
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Kelsey M. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Current address: Department of Biomedical Engineering, Columbia University, 622 W 168th St, New York, NY 10025, USA
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Lixin Chin
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Benjamin F. Dessauvagie
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
| | - Christobel M. Saunders
- Division of Surgery, Medical School, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
- Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia, 6000, Australia
| | - Brendan F. Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Western Australia, 6009, Australia
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
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30
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Wang J, Xu Y, Mesa KJ, South FA, Chaney EJ, Spillman DR, Barkalifa R, Marjanovic M, Carney PS, Higham AM, Liu ZG, Boppart SA. Complementary use of polarization-sensitive and standard OCT metrics for enhanced intraoperative differentiation of breast cancer. BIOMEDICAL OPTICS EXPRESS 2018; 9:6519-6528. [PMID: 31065446 PMCID: PMC6490989 DOI: 10.1364/boe.9.006519] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 05/19/2023]
Abstract
We report the development and implementation of an intraoperative polarization-sensitive optical coherence tomography (PS-OCT) system for enhancing breast cancer detection. A total of 3440 PS-OCT images were intraoperatively acquired from 9 human breast specimens diagnosed by H&E histology as healthy fibro-adipose tissue (n = 2), healthy stroma (n = 2), or invasive ductal carcinoma (IDC, n = 5). A standard OCT-based metric (coefficient of variation (CV)) and PS-OCT-based metrics sensitive to biological tissue from birefringence (i.e., retardation and degree of polarization uniformity (DOPU)) were derived from 398 statistically different and independent images selected by correlation coefficient analysis. We found the standard OCT-based metric and PS-OCT-based metrics were complementary for the differentiation of healthy fibro-adipose tissue, healthy stroma, and IDC. While the CV of fibro-adipose tissue was significantly higher (p<0.001) than those of either stroma or IDC, the CV difference between stroma and IDC was minimal. On the other hand, stroma was associated with significantly higher (p<0.001) retardation and significantly lower (p<0.001) DOPU as compared to IDC. By leveraging the complementary information acquired by the intraoperative PS-OCT system, healthy fibro-adipose tissue, healthy stroma, and IDC can be differentiated with an accuracy of 89.4%, demonstrating the potential of PS-OCT as an adjunct modality for enhanced intraoperative differentiation of human breast cancer.
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Affiliation(s)
- Jianfeng Wang
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Yang Xu
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Kelly J. Mesa
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Fredrick A. South
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Eric J. Chaney
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Darold R. Spillman
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ronit Barkalifa
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Marina Marjanovic
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - P. Scott Carney
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | | | | | - Stephen A. Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Bioengineering, University of Illinois at Urbana–Champaign, Urbana, Illinois, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana–Champaign Urbana, Illinois, USA
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31
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Li R, Lan L, Xia Y, Wang P, Han LK, Dunnington GL, Obeng-Gyasi S, Sandusky GE, Medley JA, Crook ST, Cheng JX. High-speed Intraoperative Assessment of Breast Tumor Margins by Multimodal Ultrasound and Photoacoustic Tomography. ACTA ACUST UNITED AC 2018; 1. [PMID: 31435620 DOI: 10.1002/mds3.10018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Conventional methods for breast tumor margins assessment need a long turnaround time, which may lead to re-operation for patients undergoing lumpectomy surgeries. Photoacoustic tomography (PAT) has been shown to visualize adipose tissue in small animals and human breast. Here, we demonstrate a customized multimodal ultrasound and PAT system for intraoperative breast tumor margins assessment using fresh lumpectomy specimens from 66 patients. The system provides the margin status of the entire excised tissue within 10 minutes. By subjective reading of three researchers, the results show 85.7% [95% confidence interval (CI), 42.0% - 99.2%] sensitivity and 84.6% (95% CI, 53.7% - 97.3%) specificity, 71.4% (95% CI, 30.3% - 94.9%) sensitivity and 92.3% (95% CI, 62.1% - 99.6%) specificity, and 100% (95% CI, 56.1% - 100%) sensitivity and 53.9% (95% CI, 26.1% - 79.6%) specificity respectively when cross-correlated with post-operational histology. Furthermore, a machine learning-based algorithm is deployed for margin assessment in the challenging ductal carcinoma in situ tissues, and achieved 85.5% (95% CI, 75.2% - 92.2%) sensitivity and 90% (95% CI, 79.9% - 95.5%) specificity. Such results present the potential of using mutlimodal ultrasound and PAT as a high-speed and accurate method for intraoperative breast tumor margins evaluation.
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Affiliation(s)
- Rui Li
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Dr., West Lafayette, Indiana, 47907, USA.,School of Biological Science and Medical Engineering, Beihang University, Beijing, China, 100083.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China, 102402
| | - Lu Lan
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Dr., West Lafayette, Indiana, 47907, USA.,Photonics Center, Boston University, 8 Saint Mary's Street, Boston, MA 02215, USA
| | - Yan Xia
- Vibronix, Inc., 1281 Win Hentschel Blvd., West Lafayette, Indiana, 47906, USA
| | - Pu Wang
- Vibronix, Inc., 1281 Win Hentschel Blvd., West Lafayette, Indiana, 47906, USA
| | - Linda K Han
- Indiana University Health Melvin and Bren Simon Cancer Center, 1030 W. Michigan St., Breast Center, Indianapolis, Indiana 46202, USA
| | - Gary L Dunnington
- Indiana University Health Melvin and Bren Simon Cancer Center, 1030 W. Michigan St., Breast Center, Indianapolis, Indiana 46202, USA
| | - Samilia Obeng-Gyasi
- Indiana University Health Melvin and Bren Simon Cancer Center, 1030 W. Michigan St., Breast Center, Indianapolis, Indiana 46202, USA
| | - George E Sandusky
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, 350 West 11th Street, Indianapolis, Indiana, 46202, USA
| | - Jennifer A Medley
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd, Indianapolis, Indiana 46202, USA
| | - Susan T Crook
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd, Indianapolis, Indiana 46202, USA
| | - Ji-Xin Cheng
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Dr., West Lafayette, Indiana, 47907, USA.,Purdue University Center for Cancer Research, 201 S. University Street, West Lafayette, Indiana, 47906, USA.,Photonics Center, Boston University, 8 Saint Mary's Street, Boston, MA 02215, USA
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32
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Maloney BW, McClatchy DM, Pogue BW, Paulsen KD, Wells WA, Barth RJ. Review of methods for intraoperative margin detection for breast conserving surgery. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-19. [PMID: 30369108 PMCID: PMC6210801 DOI: 10.1117/1.jbo.23.10.100901] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/03/2018] [Indexed: 05/18/2023]
Abstract
Breast conserving surgery (BCS) is an effective treatment for early-stage cancers as long as the margins of the resected tissue are free of disease according to consensus guidelines for patient management. However, 15% to 35% of patients undergo a second surgery since malignant cells are found close to or at the margins of the original resection specimen. This review highlights imaging approaches being investigated to reduce the rate of positive margins, and they are reviewed with the assumption that a new system would need high sensitivity near 95% and specificity near 85%. The problem appears to be twofold. The first is for complete, fast surface scanning for cellular, structural, and/or molecular features of cancer, in a lumpectomy volume, which is variable in size, but can be large, irregular, and amorphous. A second is for full, volumetric imaging of the specimen at high spatial resolution, to better guide internal radiologic decision-making about the spiculations and duct tracks, which may inform that surfaces are involved. These two demands are not easily solved by a single tool. Optical methods that scan large surfaces quickly are needed with cellular/molecular sensitivity to solve the first problem, but volumetric imaging with high spatial resolution for soft tissues is largely outside of the optical realm and requires x-ray, micro-CT, or magnetic resonance imaging if they can be achieved efficiently. In summary, it appears that a combination of systems into hybrid platforms may be the optimal solution for these two very different problems. This concept must be cost-effective, image specimens within minutes and be coupled to decision-making tools that help a surgeon without adding to the procedure. The potential for optical systems to be involved in this problem is emerging and clinical trials are underway in several of these technologies to see if they could reduce positive margin rates in BCS.
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Affiliation(s)
- Benjamin W. Maloney
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - David M. McClatchy
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Keith D. Paulsen
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Wendy A. Wells
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Geisel School of Medicine, Department of Pathology and Laboratory Medicine, Hanover, New Hampshire, United States
| | - Richard J. Barth
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Geisel School of Medicine, Department of Pathology and Laboratory Medicine, Hanover, New Hampshire, United States
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33
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Dumitru D, Douek M, Benson JR. Novel techniques for intraoperative assessment of margin involvement. Ecancermedicalscience 2018; 12:795. [PMID: 29434661 PMCID: PMC5804713 DOI: 10.3332/ecancer.2018.795] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Indexed: 12/27/2022] Open
Abstract
Breast conserving surgery (BCS) is now the standard of care for the majority of women with early stage breast cancer. There is a finite rate of ipsilateral breast tumour recurrence (IBTR) for breast conserving therapy (BCT) with annual rates of less than 1% for specialist breast practices. There has been recent consensus on the definition of an adequate resection margin for both invasive and noninvasive breast cancer treated with BCS, although some variation in margin policy persists with definitions of 'no tumour at ink', 1 and 2 mm margin mandates. Despite the development of methods for intraoperative assessment of margins, up to 20% of patients require further surgery (cavity re-excision or completion mastectomy) to achieve clear surgical margins. In the past decade, several novel technologies for intraoperative margin assessment have been explored with the aim of reducing rates of re-operation and its attendant patient anxiety, inconvenience and additional cost. Ongoing studies are addressing the safety, feasibility and cost-effectiveness of these novel technologies relative to methods in routine clinical usage.
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Affiliation(s)
- Dorin Dumitru
- The Royal Hampshire Hospitals, NHS Foundation Trust, Winchester SO22 5DG, UK
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Michael Douek
- Division of Cancer Studies, King's College, London WC2R 2LS, UK
- Guy's and St Thomas' Hospitals, NHS Foundation Trust, London SE1 9RT, UK
| | - John R Benson
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge CB2 0QQ, UK
- School of medicine, Anglia Ruskin University, Cambridge CB1 1PT, UK
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34
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Tang SSK, Kaptanis S, Haddow JB, Mondani G, Elsberger B, Tasoulis MK, Obondo C, Johns N, Ismail W, Syed A, Kissias P, Venn M, Sundaramoorthy S, Irwin G, Sami AS, Elfadl D, Baggaley A, Remoundos DD, Langlands F, Charalampoudis P, Barber Z, Hamilton-Burke WLS, Khan A, Sirianni C, Merker LAMG, Saha S, Lane RA, Chopra S, Dupré S, Manning AT, St John ER, Musbahi A, Dlamini N, McArdle CL, Wright C, Murphy JO, Aggarwal R, Dordea M, Bosch K, Egbeare D, Osman H, Tayeh S, Razi F, Iqbal J, Ledwidge SFC, Albert V, Masannat Y. Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland. Eur J Cancer 2017; 84:315-324. [PMID: 28865259 DOI: 10.1016/j.ejca.2017.07.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is variation in margin policy for breast conserving therapy (BCT) in the UK and Ireland. In response to the Society of Surgical Oncology and American Society for Radiation Oncology (SSO-ASTRO) margin consensus ('no ink on tumour' for invasive and 2 mm for ductal carcinoma in situ [DCIS]) and the Association of Breast Surgery (ABS) consensus (1 mm for invasive and DCIS), we report on current margin practice and unit infrastructure in the UK and Ireland and describe how these factors impact on re-excision rates. METHODS A trainee collaborative-led multicentre prospective study was conducted in the UK and Ireland between 1st February and 31st May 2016. Data were collected on consecutive BCT patients and on local infrastructure and policies. RESULTS A total of 79 sites participated in the data collection (75% screening units; average 372 cancers annually, range 70-900). For DCIS, 53.2% of units accept 1 mm and 38% accept 2-mm margins. For invasive disease 77.2% accept 1 mm and 13.9% accept 'no ink on tumour'. A total of 2858 patients underwent BCT with a mean re-excision rate of 17.2% across units (range 0-41%). The re-excision rate would be reduced to 15% if all units applied SSO-ASTRO guidelines and to 14.8% if all units followed ABS guidelines. Of those who required re-operation, 65% had disease present at margin. CONCLUSION There continues to be large variation in margin policy and re-excision rates across units. Altering margin policies to follow either SSO-ASTRO or ABS guidelines would result in a modest reduction in the national re-excision rate. Most re-excisions are for involved margins rather than close margins.
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MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Consensus
- Female
- Guideline Adherence/standards
- Healthcare Disparities/standards
- Humans
- Ireland
- Margins of Excision
- Mastectomy, Segmental/adverse effects
- Mastectomy, Segmental/methods
- Mastectomy, Segmental/standards
- Practice Guidelines as Topic/standards
- Practice Patterns, Physicians'/standards
- Prospective Studies
- Quality Indicators, Health Care/standards
- Reoperation
- Treatment Outcome
- United Kingdom
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Affiliation(s)
- Sarah Shuk-Kay Tang
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, England SW17 0QT, UK.
| | - Sarantos Kaptanis
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK.
| | - James B Haddow
- Queen Mary University of London, Garrod Building, Turner Street, London, England E1 2AD, UK.
| | | | - Beatrix Elsberger
- Ninewells Hospital, James Arrott Drive, Dundee, Scotland DD1 9SY, UK.
| | | | - Christine Obondo
- Stobhill Hospital, 133 Balornock Road, Glasgow, Scotland G21 3UW, UK.
| | - Neil Johns
- Edinburgh Breast Unit, Western General Hospital, Crewe Road South, Edinburgh, Scotland EH42XU, UK.
| | - Wisam Ismail
- Bradford Royal Infirmary, Duckworth Lane, Bradford, England BD9 6RJ, UK.
| | - Asim Syed
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK.
| | | | - Mary Venn
- Ipswich Hospital, Heath Road, Ipswich, England IP4 5PD, UK.
| | | | - Gareth Irwin
- Ulster Hospital, Upper Newtownards Road, Belfast, Northern Ireland BT16 1RH, UK.
| | - Amtul S Sami
- Lincoln County Hospital, Greetwell Road, Lincoln, England LN2 5QY, UK.
| | - Dalia Elfadl
- Royal Marsden Hospital, Downs Road, Sutton, England SM2 5PT, UK.
| | - Alice Baggaley
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK.
| | | | - Fiona Langlands
- Castle Hill Hospital, Castle Road, Cottingham, Hull, England HU16 5JQ, UK.
| | | | - Zoe Barber
- Neville Hall Hospital, Brecon Road, Abergavenny, Wales NP7 7EG, UK.
| | | | - Ayesha Khan
- Royal Surrey County Hospital, Egerton Road, Guildford, England GU2 7XX, UK.
| | - Chiara Sirianni
- Betsi Cadwaladr University Local Health Board, Town Hall Newry Street, Holyhead, Wales LL65 1HN, UK.
| | | | - Sunita Saha
- Broomfield Hospital, Court Road, Chelmsford, England CM1 7ET, UK.
| | - Risha Arun Lane
- Darent Valley Hospital, Darenth Wood Road, Dartford, England DA2 8DA, UK.
| | - Sharat Chopra
- Abertawe Bro Morgannwg University Health Board, 1 Talbot Gateway, Port Talbot, Wales SA12 7BR, UK.
| | - Sophie Dupré
- Guy's Hospital, Great Maze Pond, London, England SE1 9RT, UK.
| | - Aidan T Manning
- University Hospital Waterford, Dunmore Road, Waterford, Ireland.
| | - Edward R St John
- Charing Cross Hospital, Fulham Palace Road, London, England W6 8RF, UK.
| | - Aya Musbahi
- University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, England TS19 8PE, UK.
| | - Nokwanda Dlamini
- James Paget Hospital, Lowestoft Road, Great Yarmouth, England NR31 6LA, UK.
| | | | - Chloe Wright
- Bolton Breast Unit, Royal Bolton Hospital, Farnworth, Bolton, England BL4 0JR, UK.
| | - James O Murphy
- University Hospital Waterford, Dunmore Road, Waterford, Ireland.
| | - Ravi Aggarwal
- Hillingdon Hospital, Pield Heath Road, Uxbridge, England UB8 3NN, UK.
| | - Matei Dordea
- University Hospital of North Tees, Hardwick Road, Stockton-On-Tees, England TS19 8PE, UK.
| | - Karen Bosch
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Donna Egbeare
- Cardiff and Vale University Health Board, Heath Park, Cardiff, Wales CF14 4XW, UK.
| | - Hisham Osman
- Frimley Park Hospital, Portsmouth Road, Camberley, England GU16 7UJ, UK.
| | - Salim Tayeh
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK.
| | - Faraz Razi
- North Hampshire Hospital, Aldermaston Road, Basingstoke, England RG24 9NA, UK.
| | - Javeria Iqbal
- Diana Princess of Wales Hospital, Scartho Road, Grimsby, England DN33 2BA, UK.
| | | | - Vanessa Albert
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England E9 6SR, UK
| | - Yazan Masannat
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland AB25 2ZN, UK; University of Aberdeen, Aberdeen, Scotland AB24 3FX, UK; University of East Anglia, Norwich, England NR4 7TJ, UK
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Chekavar AS, Verma AK, Agarwal A, Mayilvahanan S, Sundarram T, Johri G, Bothra S. Letter to Editor: "Intra-operative assessment of excised breast tumour margins using clear edge imaging device". Eur J Surg Oncol 2017. [PMID: 28629985 DOI: 10.1016/j.ejso.2016.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A S Chekavar
- Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India.
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Dixon JM. Reply to letter to editor: "Intra-operative assessment of excised breast tumour Margins using Clear Edge imaging device". Eur J Surg Oncol 2017; 43:1604-1605. [PMID: 28318685 DOI: 10.1016/j.ejso.2017.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- J M Dixon
- Academic Office, Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, UK.
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Coble J, Reid V. Achieving clear margins. Directed shaving using MarginProbe, as compared to a full cavity shave approach. Am J Surg 2016; 213:627-630. [PMID: 28049561 DOI: 10.1016/j.amjsurg.2016.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/18/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Following lumpectomy, full cavity shaving approach is used to reduce positive margin rates, among other issues previously studied by others, at an expense of increase in tissue volume removed. We present our experience after switching from full cavity shaving to a targeted shaving approach using MarginProbe, an intra-operative margin assessment device. METHODS Specimen excision was performed according to standard of care. Additional shavings were taken based on device readings on the lumpectomy specimen. Intra-operative imaging was used, as required. RESULTS We compared 137 MarginProbe cases to 199 full cavity shave cases. The re-excision rate was reduced by 57% (P = 0.026), from 15.1% to 6.6%. The overall tissue volume removed was reduced by 32% (P = 0.0023), from 115 cc to 78 cc. CONCLUSIONS MarginProbe enabled a change in the lumpectomy technique from full cavity shavings to directed shavings guided by the device. There was a significant reduction in re-excisions and in the overall tissue volume removed.The lower amount of shavings also contributed to a reduction in pathology work.
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Affiliation(s)
- Jeffrey Coble
- University of Iowa Hospital and Clinics, 200 Hawkins Dr., Iowa City, IA 52242, USA
| | - Vincent Reid
- University of Iowa Hospital and Clinics, 200 Hawkins Dr., Iowa City, IA 52242, USA; Hall-Perrine Cancer Center: Mercy Hospital, 701 10th St, Cedar Rapids, IA 52403, USA.
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Suganya S. AA, Kochurani KJ, Nair MG, Louis JM, Sankaran S, Rajagopal R, Kumar KS, Abraham P, P. G. B, Sebastian P, Somananthan T, Maliekal TT. TM1-IR680 peptide for assessment of surgical margin and lymph node metastasis in murine orthotopic model of oral cancer. Sci Rep 2016; 6:36726. [PMID: 27827443 PMCID: PMC5101486 DOI: 10.1038/srep36726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/20/2016] [Indexed: 11/08/2022] Open
Abstract
Treatment outcome after surgical removal in oral carcinoma is poor due to inadequate methodologies available for marking surgical margins. Even though some methodologies for intraoperative margin assessment are under clinical and preclinical trials for other solid tumours, a promising modality for oral cancer surgery is not developed. Fluorescent-based optical imaging using Near Infrared (NIR) dyes tagged to tumour specific target will be an optimal tool for this purpose. One such target, Gastrin Releasing Peptide Receptor (GRPR) was selected for the study, and its binding peptide, TM1-IR680, was tested for its efficacy for surgical margin prediction in murine orthotopic model of oral cancer, derived from primary samples. Here, for the first time in a preclinical analysis, we show that the size and margin of oral cancer can be predicted, as revealed by 3D-imaging. Interestingly, the peptide was sensitive enough to detect lymph nodes that harboured dispersed tumour cells before colonization, which was impossible to identify by conventional histopathology. We recommend the use of TM1-NIR dyes alone or in combination with other technologies to improve the clinical outcome of oral cancer surgery.
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Affiliation(s)
- Annie A. Suganya S.
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - K. J. Kochurani
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - Madhumathy G. Nair
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - Jiss Maria Louis
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - Santhosh Sankaran
- Animal Research Facility, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - R. Rajagopal
- Animal Research Facility, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - K. Santhosh Kumar
- Chemical Biology Group, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - Parvin Abraham
- Chemical Biology Group, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - Balagopal P. G.
- Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, 695011, India
| | - Paul Sebastian
- Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, 695011, India
| | - Thara Somananthan
- Division of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, 695011, India
| | - Tessy Thomas Maliekal
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
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Jermyn M, Desroches J, Aubertin K, St-Arnaud K, Madore WJ, De Montigny E, Guiot MC, Trudel D, Wilson BC, Petrecca K, Leblond F. A review of Raman spectroscopy advances with an emphasis on clinical translation challenges in oncology. Phys Med Biol 2016; 61:R370-R400. [DOI: 10.1088/0031-9155/61/23/r370] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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40
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Dixon JM, Renshaw L, Young O, Kulkarni D, Saleem T, Sarfaty M, Sreenivasan R, Kusnick C, Thomas J, Williams LJ. Intra-operative assessment of excised breast tumour margins using ClearEdge imaging device. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:1834-1840. [PMID: 27591938 DOI: 10.1016/j.ejso.2016.07.141] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/04/2016] [Accepted: 07/14/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast conserving surgery (BCS) aims to remove a breast cancer completely and obtain clear margins. Complete excision is essential to reduce the risk of local recurrence. The ClearEdge™ (CE) imaging device examines margins of excised breast tissue intra-operatively. The aim of this study was to investigate the potential of the device in detecting margin involvement in patients having BCS. METHODS In Phase-1 58 patients underwent BCS and had 334 margins assessed by the device. In Phase-2 the device was used in 63 patients having BCS and 335 margins were assessed. Patients with margins considered close or involved by the CE device were re-excised. RESULTS The margin assessment accuracies in Phase-1 and Phase-2 compared to permanent section pathology were very similar: sensitivity (84.3% and 87.3%), specificity (81.9% and 75.6%), positive predictive value (67.2% and 63.6%), and negative predictive value (92.2% and 92.4%). The false positive rate (18.1% and 24.4%) and false negative rate (15.7% and 12.7%) were low in both phases. In Phase-2 re-excision rate was 37%, but in the 54 where the CE device was used appropriately the re-excision rate was 17%. Had all surgeons interpreted all images appropriately and re-excised margins detected as abnormal by the device in Phase-2 then the re-excision rate would have been 7%. CONCLUSION This study shows that the CE device has potential to reduce re-excision after BCS and further randomized studies of its value are warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/complications
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/complications
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/surgery
- Dielectric Spectroscopy/instrumentation
- Dielectric Spectroscopy/methods
- Female
- Humans
- Intraoperative Period
- Male
- Margins of Excision
- Mastectomy, Segmental
- Middle Aged
- Neoplasm, Residual
- Predictive Value of Tests
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Affiliation(s)
- J M Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK; University of Edinburgh, Medical School, Scotland, UK.
| | - L Renshaw
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - O Young
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - D Kulkarni
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | - T Saleem
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, UK
| | | | | | | | - J Thomas
- Pathology Department, Western General Hospital, Edinburgh, Scotland, UK
| | - L J Williams
- University of Edinburgh, Medical School, Scotland, UK
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O'Kelly Priddy CM, Forte VA, Lang JE. The importance of surgical margins in breast cancer. J Surg Oncol 2015; 113:256-63. [PMID: 26394558 DOI: 10.1002/jso.24047] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 12/22/2022]
Abstract
Achieving negative margins with "no tumor on ink" is an appropriate goal in breast conserving therapy (BCT). Wider margins do not decrease recurrence rates, and re-excision in patients with microscopic positive margins is warranted. Several strategies exist to increase rates of negative margins, including techniques to improve tumor localization, intraoperative assessment of margins and oncoplastic techniques. Negative margins should be the goal of BCT, as this will improve both local control and long-term survival.
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Affiliation(s)
- Colleen M O'Kelly Priddy
- Department of Surgery, Section of Breast Soft Tissue Surgery, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Victoria A Forte
- Department of Medicine, Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Julie E Lang
- Department of Surgery, Section of Breast Soft Tissue Surgery, USC Norris Comprehensive Cancer Center, Los Angeles, California
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Sebastian M, Akbari S, Anglin B, Lin EH, Police AM. The impact of use of an intraoperative margin assessment device on re-excision rates. SPRINGERPLUS 2015; 4:198. [PMID: 26020017 PMCID: PMC4441646 DOI: 10.1186/s40064-015-0801-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 11/10/2022]
Abstract
Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. An intraoperative margin assessment tool (MarginProbe) has been approved for use in the US since 2013. This study is the first compilation of data from routine use of the device, to assess the impact of device utilization on re-excision rates. We present a retrospective, observational, review from groups of consecutive patients, before and after the implementation of intraoperative use of the device during lumpectomy procedures. Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also, when feasible, imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. For each surgeon, historical re-excision rates were established based on a consecutive set of patients from a time period proximal to initiation of use of the device. From March 2013 to April 2014 the device was routinely used by 4 surgeons in 3 centers. In total, 165 cases lumpectomy cases were performed. Positive margins resulted in additional re-excision procedures in 9.7% (16/165) of the cases. The corresponding historical set from 2012 and 2013 consisted of 186 Lumpectomy cases, in which additional re-excision procedures were performed in 25.8% (48/186) of the cases. The reduction in the rate of re-excision procedures was significant 62% (P < 0.0001). Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively.
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Affiliation(s)
- Molly Sebastian
- />Virginia Hospital Center, Reinsch Pierce Family Center for Breast Health, 1625 N George Mason Dr, Arlington, VA 22205 USA
| | - Stephanie Akbari
- />Virginia Hospital Center, Reinsch Pierce Family Center for Breast Health, 1625 N George Mason Dr, Arlington, VA 22205 USA
| | - Beth Anglin
- />Medical Center of Plano, Complete Breast Care, 3801 W. 15th Street Building A, Suite 210, Plano, TX 75075 USA
| | - Erin H Lin
- />Department of Surgery, University of California Irvine Medical Center, 333 City Blvd. West, Suite 1600, Orange, CA 92868 USA
| | - Alice M Police
- />Department of Surgery, University of California Irvine Medical Center, 333 City Blvd. West, Suite 1600, Orange, CA 92868 USA
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Trifiletti DM, Jones R, Showalter SL, Libby BB, Brenin DR, Schroen A, Morris MM, Reardon KA, Showalter TN. Techniques for intraoperative radiation therapy for early-stage breast carcinoma. Future Oncol 2015; 11:1047-58. [DOI: 10.2217/fon.15.26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
ABSTRACT Intraoperative radiation therapy (IORT) is a method of accelerated partial breast irradiation developed to replace other longer courses of radiotherapy with a single radiation session administered at the time of breast-conserving surgery. The purpose of this review is to summarize the advantages and disadvantages of breast IORT techniques that are currently available, as well to consider potential alternative techniques for breast IORT or ultra-short course breast radiotherapy. Furthermore, we highlight the published outcomes for the IORT treatment approaches including: electron therapy, superficial photon therapy and other techniques. Potential future directions of IORT are explored including novel IORT techniques utilizing intraoperative brachytherapy with in-room imaging and rapid treatment planning.
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Affiliation(s)
- Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ryan Jones
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Shayna L Showalter
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bruce B Libby
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - David R Brenin
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Anneke Schroen
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Monica M Morris
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kelli A Reardon
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Li R, Wang P, Lan L, Lloyd FP, Goergen CJ, Chen S, Cheng JX. Assessing breast tumor margin by multispectral photoacoustic tomography. BIOMEDICAL OPTICS EXPRESS 2015; 6:1273-81. [PMID: 25909011 PMCID: PMC4399666 DOI: 10.1364/boe.6.001273] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 05/18/2023]
Abstract
An unmet need exists in high-speed and highly-sensitive intraoperative assessment of breast cancer margin during conservation surgical procedures. Here, we demonstrate a multispectral photoacoustic tomography system for breast tumor margin assessment using fat and hemoglobin as contrasts. This system provides ~3 mm tissue depth and ~125 μm axial resolution. The results agreed with the histological findings. A high sensitivity in margin assessment was accomplished, which opens a compelling way to intraoperative margin assessment.
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Affiliation(s)
- Rui Li
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive., West Lafayette, Indiana, 47907,
USA
- Authors contributed equally
| | - Pu Wang
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive., West Lafayette, Indiana, 47907,
USA
- Authors contributed equally
| | - Lu Lan
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive., West Lafayette, Indiana, 47907,
USA
| | - Frank P. Lloyd
- Surgical Oncology- Cascade Metrix/Putman County Hospital, 1542 S Bloomington Street, Greencastle, Indiana, 46135,
USA
| | - Craig J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive., West Lafayette, Indiana, 47907,
USA
- Purdue University Center for Cancer Research, 201 S. University Street, West Lafayette, Indiana, 47906,
USA
| | - Shaoxiong Chen
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 350 West 11th Street, Indianapolis, Indiana, 46202,
USA
| | - Ji-Xin Cheng
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive., West Lafayette, Indiana, 47907,
USA
- Department of Chemistry, Purdue University, 560 Oval Drive, West Lafayette, Indiana, 47907,
USA
- Purdue University Center for Cancer Research, 201 S. University Street, West Lafayette, Indiana, 47906,
USA
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45
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Thill M, Baumann K, Barinoff J. Intraoperative assessment of margins in breast conservative surgery--still in use? J Surg Oncol 2014; 110:15-20. [PMID: 24863286 DOI: 10.1002/jso.23634] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/05/2014] [Indexed: 01/20/2023]
Abstract
A positive margin in breast conserving surgery is associated with an increased risk of local recurrence. Failure to achieve clear margins results in re-excision procedures. Methods for intraoperative assessment of margins have been developed, such as frozen section analysis, touch preparation cytology, near-infrared fluorescence optical imaging, x-ray diffraction technology, high-frequency ultrasound, micro-CT, and radiofrequency spectroscopy. In this article, options that might become the method of choice in the future are discussed.
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Affiliation(s)
- Marc Thill
- Department of Gynecology and Obstetrics, Breast Center, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
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46
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Schnabel F, Boolbol SK, Gittleman M, Karni T, Tafra L, Feldman S, Police A, Friedman NB, Karlan S, Holmes D, Willey SC, Carmon M, Fernandez K, Akbari S, Harness J, Guerra L, Frazier T, Lane K, Simmons RM, Estabrook A, Allweis T. A randomized prospective study of lumpectomy margin assessment with use of MarginProbe in patients with nonpalpable breast malignancies. Ann Surg Oncol 2014; 21:1589-95. [PMID: 24595800 PMCID: PMC3975090 DOI: 10.1245/s10434-014-3602-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Indexed: 12/17/2022]
Abstract
Background The presence of tumor cells at the margins of breast lumpectomy specimens is associated with an increased risk of ipsilateral tumor recurrence. Twenty to 30 % of patients undergoing breast-conserving surgery require second procedures to achieve negative margins. This study evaluated the adjunctive use of the MarginProbe device (Dune Medical Devices Ltd, Caesarea, Israel) in providing real-time intraoperative assessment of lumpectomy margins. Methods This multicenter randomized trial enrolled patients with nonpalpable breast malignancies. The study evaluated MarginProbe use in addition to standard intraoperative methods for margin assessment. After specimen removal and inspection, patients were randomized to device or control arms. In the device arm, MarginProbe was used to examine the main lumpectomy specimens and direct additional excision of positive margins. Intraoperative imaging was used in both arms; no intraoperative pathology assessment was permitted. Results
In total, 596 patients were enrolled. False-negative rates were 24.8 and 66.1 % and false-positive rates were 53.6 and 16.6 % in the device and control arms, respectively. All positive margins on positive main specimens were resected in 62 % (101 of 163) of cases in the device arm, versus 22 % (33 of 147) in the control arm (p < 0.001). A total of 19.8 % (59 of 298) of patients in the device arm underwent a reexcision procedure compared with 25.8 % (77 of 298) in the control arm (6 % absolute, 23 % relative reduction). The difference in tissue volume removed was not significant. Conclusions Adjunctive use of the MarginProbe device during breast-conserving surgery improved surgeons’ ability to identify and resect positive lumpectomy margins in the absence of intraoperative pathology assessment, reducing the number of patients requiring reexcision. MarginProbe may aid performance of breast-conserving surgery by reducing the burden of reexcision procedures for patients and the health care system.
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Affiliation(s)
- Freya Schnabel
- Department of Surgery, NYU Langone Medical Center, NYU Clinical Cancer Center, New York, NY, USA,
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MarginProbe® – Final results of the German post-market study in breast conserving surgery of ductal carcinoma in situ. Breast 2014; 23:94-6. [DOI: 10.1016/j.breast.2013.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 08/28/2013] [Accepted: 11/03/2013] [Indexed: 11/24/2022] Open
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48
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Butler-Henderson K, Lee AH, Price RI, Waring K. Intraoperative assessment of margins in breast conserving therapy: a systematic review. Breast 2014; 23:112-9. [PMID: 24468464 DOI: 10.1016/j.breast.2014.01.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/14/2013] [Accepted: 01/05/2014] [Indexed: 11/28/2022] Open
Abstract
Approximately one quarter of patients undergoing breast conserving therapy for breast cancer will require a second operation to achieve adequate clearance of the margins. A number of techniques to assess margins intraoperatively have been reported. This systematic review examines current intraoperative methods for assessing margin status. The final pathology status, statistical measures including accuracy of tumour margin assessment, average time impact on the procedure and second operation rate, were used as criteria for comparison between studies. Although pathological methods, such as frozen section and imprint cytology performed well, they added on average 20-30 min to operation times. An ultrasound probe allows accurate examination of the margins and delivers results in a timely manner, yet it has a limited role with DCIS where calcification is present and in multifocal cancer. Further research is required in other intraoperative margin assessment techniques, such as mammography, radiofrequency spectroscopy and optical coherence tomography.
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Affiliation(s)
- Kerryn Butler-Henderson
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Andy H Lee
- School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Roger I Price
- Medical Technology & Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia; School of Physics, University of Western Australia, Nedlands, Western Australia 6009, Australia.
| | - Kaylene Waring
- Patient Information Service, Armadale Health Service, PO Box 460, Armadale, Western Australia 6992, Australia.
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