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Fan S, Zhang H, Meng Z, Li A, Luo Y, Liu Y. Comparing the diagnostic efficacy of optical coherence tomography and frozen section for margin assessment in breast-conserving surgery: a meta-analysis. J Clin Pathol 2024; 77:517-527. [PMID: 38862215 DOI: 10.1136/jcp-2024-209597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
AIMS This meta-analysis assessed the relative diagnostic accuracy of optical coherence tomography (OCT) versus frozen section (FS) in evaluating surgical margins during breast-conserving procedures. METHODS PubMed and Embase were searched for relevant studies published up to October 2023. The inclusion criteria encompassed studies evaluating the diagnostic accuracy of OCT or FS in patients undergoing breast-conserving surgery. Sensitivity and specificity were analysed using the DerSimonian and Laird method and subsequently transformed through the Freeman-Tukey double inverse sine method. RESULTS The meta-analysis encompassed 36 articles, comprising 16 studies on OCT and 20 on FS, involving 10 289 specimens from 8058 patients. The overall sensitivity of OCT was 0.93 (95% CI: 0.90 to 0.96), surpassing that of FS, which was 0.82 (95% CI: 0.71 to 0.92), indicating a significantly higher sensitivity for OCT (p=0.04). Conversely, the overall specificity of OCT was 0.89 (95% CI: 0.83 to 0.94), while FS exhibited a higher specificity at 0.97 (95% CI: 0.95 to 0.99), suggesting a superior specificity for FS (p<0.01). CONCLUSIONS Our meta-analysis reveals that OCT offers superior sensitivity but inferior specificity compared with FS in assessing surgical margins in breast-conserving surgery patients. Further larger well-designed prospective studies are needed, especially those employing a head-to-head comparison design. PROSPERO REGISTRATION NUMBER CRD42023483751.
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Affiliation(s)
- Shishun Fan
- Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huirui Zhang
- Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhenyu Meng
- Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ang Li
- Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuqing Luo
- Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yueping Liu
- Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Wang H, Chen A, Wang K, Yang H, Wen W, Ren Q, Chen L, Xu X, Zhu Q. CT imaging features of lung ground-glass nodule patients with upgraded intraoperative frozen pathology. Discov Oncol 2024; 15:29. [PMID: 38310621 PMCID: PMC10838864 DOI: 10.1007/s12672-024-00872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024] Open
Abstract
PURPOSE Intraoperative frozen section pathology (FS) is widely used to guide surgical strategies while the accuracy is relatively low. Underestimating the pathological condition may result in inadequate surgical margins. This study aims to identify CT imaging features related to upgraded FS and develop a predictive model. METHODS Collected data from 860 patients who underwent lung surgery from January to December 2019. We analyzed the consistency rate of FS and categorized the patients into three groups: Group 1 (n = 360) had both FS and Formalin-fixed Paraffin-embedded section (FP) as non-invasive adenocarcinoma (IAC); Group 2 (n = 128) had FS as non-IAC but FP as IAC; Group 3 (n = 372) had both FS and FP as IAC. Clinical baseline characteristics were compared and propensity score adjustment was used to mitigate the effects of these characteristics. Univariate analyses identified imaging features with inter-group differences. A multivariate analysis was conducted to screen independent risk factors for FS upgrade, after which a logistic regression prediction model was established and a receiver operating characteristic (ROC) curve was plotted. RESULTS The consistency rate of FS with FP was 84.19%. 26.67% of the patients with non-IAC FS diagnosis were upgraded to IAC. The predictive model's Area Under Curve (AUC) is 0.785. Consolidation tumor ratio (CTR) ≤ 0.5 and smaller nodule diameter are associated with the underestimation of IAC in FS. CONCLUSION CT imaging has the capacity to effectively detect patients at risk of upstaging during FS.
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Affiliation(s)
- Hongya Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Aiping Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Kun Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - He Yang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Wei Wen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qianrui Ren
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xinfeng Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Quan Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Liu HC, Lin MH, Chang WC, Zeng RC, Wang YM, Sun CW. Rapid On-Site AI-Assisted Grading for Lung Surgery Based on Optical Coherence Tomography. Cancers (Basel) 2023; 15:5388. [PMID: 38001648 PMCID: PMC10670228 DOI: 10.3390/cancers15225388] [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: 10/03/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
The determination of resection extent traditionally relies on the microscopic invasiveness of frozen sections (FSs) and is crucial for surgery of early lung cancer with preoperatively unknown histology. While previous research has shown the value of optical coherence tomography (OCT) for instant lung cancer diagnosis, tumor grading through OCT remains challenging. Therefore, this study proposes an interactive human-machine interface (HMI) that integrates a mobile OCT system, deep learning algorithms, and attention mechanisms. The system is designed to mark the lesion's location on the image smartly and perform tumor grading in real time, potentially facilitating clinical decision making. Twelve patients with a preoperatively unknown tumor but a final diagnosis of adenocarcinoma underwent thoracoscopic resection, and the artificial intelligence (AI)-designed system mentioned above was used to measure fresh specimens. Results were compared to FSs benchmarked on permanent pathologic reports. Current results show better differentiating power among minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IA), and normal tissue, with an overall accuracy of 84.9%, compared to 20% for FSs. Additionally, the sensitivity and specificity, the sensitivity and specificity were 89% and 82.7% for MIA and 94% and 80.6% for IA, respectively. The results suggest that this AI system can potentially produce rapid and efficient diagnoses and ultimately improve patient outcomes.
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Affiliation(s)
- Hung-Chang Liu
- Section of Thoracic Surgery, Mackay Memorial Hospital, Taipei City 10449, Taiwan;
- Intensive Care Unit, Mackay Memorial Hospital, Taipei City 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan
- Department of Optometry, Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Miao-Hui Lin
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan; (M.-H.L.); (R.-C.Z.); (Y.-M.W.)
| | - Wei-Chin Chang
- Department of Pathology, Mackay Memorial Hospital, New Taipei City 25160, Taiwan;
- Department of Pathology, Taipei Medical University Hospital, Taipei City 11030, Taiwan
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11030, Taiwan
| | - Rui-Cheng Zeng
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan; (M.-H.L.); (R.-C.Z.); (Y.-M.W.)
| | - Yi-Min Wang
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan; (M.-H.L.); (R.-C.Z.); (Y.-M.W.)
| | - Chia-Wei Sun
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan; (M.-H.L.); (R.-C.Z.); (Y.-M.W.)
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan
- Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, Taipei City 11259, Taiwan
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Liu HC, Lin MH, Ting CH, Wang YM, Sun CW. Intraoperative application of optical coherence tomography for lung tumor. JOURNAL OF BIOPHOTONICS 2023; 16:e202200344. [PMID: 36755475 DOI: 10.1002/jbio.202200344] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/06/2023] [Accepted: 01/18/2023] [Indexed: 06/07/2023]
Abstract
On-site instant determination of benign or malignant tumors for deciding the types of resection is crucial during pulmonary surgery. We designed a portable spectral-domain optical coherence tomography (SD-OCT) system to do real-time scanning intraoperatively for the distinction of fresh tumor specimens in the lung. A total of 12 ex vivo lung specimens from six patients were enrolled. Three patients were diagnosed with invasive adenocarcinoma (IA), while the others were benign. After OCT-imaged reconstruction, we compared the qualitative morphology of OCT and histology among malignant, benign, and normal tissues. In addition, through analysis of the quantitative data, a discrete difference in optical attenuation coefficients around the junctional surface was shown by our data processing. This study demonstrated a feasible OCT-assisted resection guide by a rapid on-site tumor diagnosis. The results indicate that future deep learning of OCT-captured image systems able to improve diagnostic and therapeutic efficiency is warranted.
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Affiliation(s)
- Hung-Chang Liu
- Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
| | - Miao-Hui Lin
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan
| | - Ching-Heng Ting
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
- Department of Pathology, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Min Wang
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan
| | - Chia-Wei Sun
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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A deep-learning model for transforming the style of tissue images from cryosectioned to formalin-fixed and paraffin-embedded. Nat Biomed Eng 2022; 6:1407-1419. [PMID: 36564629 DOI: 10.1038/s41551-022-00952-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/09/2022] [Indexed: 12/24/2022]
Abstract
Histological artefacts in cryosectioned tissue can hinder rapid diagnostic assessments during surgery. Formalin-fixed and paraffin-embedded (FFPE) tissue provides higher quality slides, but the process for obtaining them is laborious (typically lasting 12-48 h) and hence unsuitable for intra-operative use. Here we report the development and performance of a deep-learning model that improves the quality of cryosectioned whole-slide images by transforming them into the style of whole-slide FFPE tissue within minutes. The model consists of a generative adversarial network incorporating an attention mechanism that rectifies cryosection artefacts and a self-regularization constraint between the cryosectioned and FFPE images for the preservation of clinically relevant features. Transformed FFPE-style images of gliomas and of non-small-cell lung cancers from a dataset independent from that used to train the model improved the rates of accurate tumour subtyping by pathologists.
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Qian L, Zhou Y, Zeng W, Chen X, Ding Z, Shen Y, Qian Y, Tosi D, Silva M, Han Y, Fu X. A random forest algorithm predicting model combining intraoperative frozen section analysis and clinical features guides surgical strategy for peripheral solitary pulmonary nodules. Transl Lung Cancer Res 2022; 11:1132-1144. [PMID: 35832446 PMCID: PMC9271446 DOI: 10.21037/tlcr-22-395] [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: 03/28/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
Background Intraoperative frozen section (FS) analysis has been used to guide the extent of resection in patients with solitary pulmonary nodules (SPNs), but its accuracy varies greatly among different hospitals. Artificial intelligence (AI) and multidimensional data technology are developing rapidly these years, meanwhile, surgeons need better methods to guide the surgical strategy of SPNs. We established predicting models combining FS results with multidimensional perioperative clinical features using logistic regression analysis and the random forest (RF) algorithm to get more accurate extent of SPN resection. Methods Patients with peripheral SPNs who underwent FS-guided surgical resection at the Shanghai Chest Hospital (January 2017-December 2018) were retrospectively examined (N=3,089). The accuracy of intraoperative FS-guided resection extent was analyzed and used as Model 1. The clinical features (sex, age, CT features, tumor markers, smoking history, lesion size and nodule location) of patients were collected, and Models 2 and 3 were established using logistic regression and RF algorithms to combine the FS with clinical features. We confirmed the performance of these models in an external validation cohort of 117 patients from Hwa Mei Hospital, University of Chinese Academy of Science (Ningbo No. 2 Hospital). We compared the effectiveness in classifying low/high-risk groups of SPN among them. Results The accuracy of FS analysis was 61.3%. Model 3 exhibited the best diagnostic accuracy and had an area under the curve of 0.903 in n the internal validation cohort and 0.919 in the external validation cohort. The calibration plots and net reclassification index (NRI) of Model 3 also exhibited significantly better performance than the other models. Improved diagnostic accuracy was observed in in both internal and external validation cohort. Conclusions Using an RF algorithm, clinical characteristics can be combined with intraoperative FS analysis to significantly improve intraoperative judgment accuracy for low- and high-risk tumors, and may serve as a reliable complementary method when FS evaluation is equivocal, improving the accuracy of the extent of surgical resection.
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Affiliation(s)
- Liqiang Qian
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinjie Zhou
- Department of Thoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Science (Ningbo No. 2 Hospital), Ningbo, China
| | - Wanqin Zeng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoke Chen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhengping Ding
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yujia Shen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yifeng Qian
- National Clinical Research Center for Oral Disease, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Lu D, Yang J, Liu X, Feng S, Dong X, Shi X, Zhai J, Mai S, Jiang J, Wang Z, Wu H, Cai K. Authors' response: Comment on "clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma". Cancer Med 2022; 11:2038-2039. [PMID: 35142110 PMCID: PMC9089219 DOI: 10.1002/cam4.4585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Di Lu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianjun Yang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiguang Liu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoying Dong
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoshun Shi
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianxue Zhai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shijie Mai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianjun Jiang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhizhi Wang
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hua Wu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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