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van der Zee JM, Fitski M, van de Sande MAJ, Buser MAD, Hiep MAJ, Terwisscha van Scheltinga CEJ, Hulsker CCC, van den Bosch CH, van de Ven CP, van der Heijden L, Bökkerink GMJ, Wijnen MHWA, Siepel FJ, van der Steeg AFW. Tracked ultrasound registration for intraoperative navigation during pediatric bone tumor resections with soft tissue components: a porcine cadaver study. Int J Comput Assist Radiol Surg 2024; 19:297-302. [PMID: 37924438 PMCID: PMC10838821 DOI: 10.1007/s11548-023-03021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/12/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Resection of pediatric osteosarcoma in the extremities with soft tissue involvement presents surgical challenges due to difficult visualization and palpation of the tumor. Therefore, an adequate image-guided surgery (IGS) system is required for more accurate tumor resection. The use of a 3D model in combination with intraoperative tracked ultrasound (iUS) may enhance surgical decision making. This study evaluates the clinical feasibility of iUS as a surgical tool using a porcine cadaver model. METHODS First, a 3D model of the porcine lower limb was created based on preoperative scans. Second, the bone surface of the tibia was automatically detected with an iUS by a sweep on the skin. The bone surface of the preoperative 3D model was then matched with the bone surface detected by the iUS. Ten artificial targets were used to calculate the target registration error (TRE). Intraoperative performance of iUS IGS was evaluated by six pediatric surgeons and two pediatric oncologic orthopedists. Finally, user experience was assessed with a post-procedural questionnaire. RESULTS Eight registration procedures were performed with a mean TRE of 6.78 ± 1.33 mm. The surgeons agreed about the willingness for clinical implementation in their current clinical practice. They mentioned the additional clinical value of iUS in combination with the 3D model for the localization of the soft tissue components of the tumor. The concept of the proposed IGS system is considered feasible by the clinical panel, but the large TRE and degree of automation need to be addressed in further work. CONCLUSION The participating pediatric surgeons and orthopedists were convinced of the clinical value of the interaction between the iUS and the 3D model. Further research is required to improve the surgical accuracy and degree of automation of iUS-based registration systems for the surgical management of pediatric osteosarcoma.
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Affiliation(s)
- J M van der Zee
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Technical Medicine, TechMed Centre, University of Twente, Enschede, The Netherlands.
| | - M Fitski
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M A J van de Sande
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - M A D Buser
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M A J Hiep
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - C C C Hulsker
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C H van den Bosch
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C P van de Ven
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - L van der Heijden
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - G M J Bökkerink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - F J Siepel
- Robotics and Mechatronics, TechMed Centre, University of Twente, Enschede, The Netherlands
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Lebbink CA, Dekker BL, Bocca G, Braat AJAT, Derikx JPM, Dierselhuis MP, de Keizer B, Kruijff S, Kwast ABG, van Nederveen FH, Nieveen van Dijkum EJM, Nievelstein RAJ, Peeters RP, Terwisscha van Scheltinga CEJ, Tissing WJE, van der Tuin K, Vriens MR, Zsiros J, van Trotsenburg ASP, Links TP, van Santen HM. New national recommendations for the treatment of pediatric differentiated thyroid carcinoma in the Netherlands. Eur J Endocrinol 2020; 183:P11-P18. [PMID: 32698145 DOI: 10.1530/eje-20-0191] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Currently, there are no European recommendations for the management of pediatric thyroid cancer. Other current international guidelines are not completely concordant. In addition, medical regulations differ between, for instance, the US and Europe. We aimed to develop new, easily accessible national recommendations for differentiated thyroid carcinoma (DTC) patients <18 years of age in the Netherlands as a first step toward a harmonized European Recommendation. METHODS A multidisciplinary working group was formed including pediatric and adult endocrinologists, a pediatric radiologist, a pathologist, endocrine surgeons, pediatric surgeons, pediatric oncologists, nuclear medicine physicians, a clinical geneticist and a patient representative. A systematic literature search was conducted for all existing guidelines and review articles for pediatric DTC from 2000 until February 2019. The Appraisal of Guidelines, Research and Evaluation (AGREE) instrument was used for assessing quality of the articles. All were compared to determine dis- and concordances. The American Thyroid Association (ATA) pediatric guideline 2015 was used as framework to develop specific Dutch recommendations. Discussion points based upon expert opinion and current treatment management of DTC in children in the Netherlands were identified and elaborated. RESULTS Based on the most recent evidence combined with expert opinion, a 2020 Dutch recommendation for pediatric DTC was written and published as an online interactive decision tree (www.oncoguide.nl). CONCLUSION Pediatric DTC requires a multidisciplinary approach. The 2020 Dutch Pediatric DTC Recommendation can be used as a starting point for the development of a collaborative European recommendation for treatment of pediatric DTC.
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Affiliation(s)
- C A Lebbink
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital (WKZ)/University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - B L Dekker
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - G Bocca
- Department of Pediatric Endocrinology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - A J A T Braat
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - J P M Derikx
- Department of Pediatric Surgery, Pediatric Surgical Center of Amsterdam, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M P Dierselhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - B de Keizer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - S Kruijff
- Division of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - A B G Kwast
- Comprehensive Cancer Center, The Netherlands
| | | | - E J M Nieveen van Dijkum
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R A J Nievelstein
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - R P Peeters
- Department of Endocrinology, Erasmus Medical Center (EMC), Rotterdam, The Netherlands
| | | | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - K van der Tuin
- Department of Clinical Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - M R Vriens
- Department of Surgery, Wilhelmina Children's Hospital (WKZ)/University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - J Zsiros
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - T P Links
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital (WKZ)/University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Jeremiasse B, van den Bosch CH, Wijnen MWHA, Terwisscha van Scheltinga CEJ, Fiocco MF, van der Steeg AFW. Systematic review and meta-analysis concerning near-infrared imaging with fluorescent agents to identify the sentinel lymph node in oncology patients. Eur J Surg Oncol 2020; 46:2011-2022. [PMID: 32826112 DOI: 10.1016/j.ejso.2020.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 02/05/2023] Open
Abstract
Sentinel node procedures (SNP) are performed with the use of tracer-agents, mainly radio-colloid and/or blue dye. Fluorescent agents have emerged as a new tracer-agent to identify the SLN intra-operatively with near-infrared imaging. Our aim is to compare the detection rate of fluorescent agents to current "golden standards" (blue dye and/or radio-colloid) for the SNP by means of a systematic review and meta-analysis without any restrictions based on tumor type. A systematic search in PubMed, Embase and The Cochrane Library was performed. Articles that compared the detection rates of fluorescent agents with radio-colloid and/or blue dye were included. Meta-analyses were performed for breast, gynecological and dermatological cancer using a random effects model. In total 6195 articles were screened which resulted in a final inclusion of 55 articles. All studies used indocyanine green (ICG) as fluorescent agent. Meta-analyses comparing ICG with blue dye showed a significant and clinically relevant difference in detection rate in favor of ICG, for both breast, dermatological and gynecological cancer. Meta-analyses comparing ICG with radio-colloid did not show any significant differences, with the exception of ICG versus radio-colloid + blue dye for the bilateral SLN detection in gynecological cancer. Near-infrared fluorescence imaging using ICG provides a higher detection rate compared to blue dye for the SNP in a range of different tumor types. SLN detection rates of ICG are comparable to radio-colloid. Due to their complementary characteristics in terms of spatial resolution and transdermal sensitivity, we suggest to use a combination of both ICG and a radio-colloid.
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Affiliation(s)
- B Jeremiasse
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | - C H van den Bosch
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | - M W H A Wijnen
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | | | - M F Fiocco
- Trial and Data Center, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands; Institute of Mathematics, Leiden University, Niels Bohrweg 1, 2333CA, Leiden, the Netherlands; Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2300RC, Leiden, the Netherlands.
| | - A F W van der Steeg
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
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Wellens LM, Meulstee J, van de Ven CP, Terwisscha van Scheltinga CEJ, Littooij AS, van den Heuvel-Eibrink MM, Fiocco M, Rios AC, Maal T, Wijnen MHWA. Comparison of 3-Dimensional and Augmented Reality Kidney Models With Conventional Imaging Data in the Preoperative Assessment of Children With Wilms Tumors. JAMA Netw Open 2019; 2:e192633. [PMID: 31002326 PMCID: PMC6481457 DOI: 10.1001/jamanetworkopen.2019.2633] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Nephron-sparing surgery can be considered in well-defined cases of unilateral and bilateral Wilms tumors, but the surgical procedure can be very challenging for the pediatric surgeon to perform. OBJECTIVE To assess the added value of personalized 3-dimensional (3-D) kidney models derived from conventional imaging data to enhance preoperative surgical planning. DESIGN, SETTING, AND PARTICIPANTS In a survey study, the conventional imaging data of 10 Dutch children with Wilms tumors were converted to 3-D prints and augmented reality (AR) holograms and a panel of pediatric oncology surgeons (n = 7) assessed the quality of the different imaging methods during preoperative evaluation. Kidney models were created with 3-D printing and AR using a mixed reality headset for visualization. MAIN OUTCOMES AND MEASURES Differences in the assessment of 4 anatomical structures (tumor, arteries, veins, and urinary collecting structures) using questionnaires. A Likert scale measured differences between the imaging methods, with scores ranging from 1 (completely disagree) to 5 (completely agree). RESULTS Of the 10 patients, 7 were girls, and the mean (SD) age was 3.7 (1.7) years. Compared with conventional imaging, the 3-D print and the AR hologram models were evaluated by the surgeons to be superior for all anatomical structures: tumor (median scores for conventional imaging, 4.07; interquartile range [IQR], 3.62-4.15 vs 3-D print, 4.67; IQR, 4.14-4.71; P = .008 and AR hologram, 4.71; IQR, 4.26-4.75; P = .002); arteries (conventional imaging, 3.62; IQR, 3.43-3.93 vs 3-D print, 4.54; IQR, 4.32-4.71; P = .002 and AR hologram, 4.83; IQR, 4.64-4.86; P < .001), veins (conventional imaging, 3.46; IQR 3.39-3.62 vs 3-D print, 4.50; IQR, 4.39-4.68; P < .001 and AR hologram, 4.83; IQR, 4.71-4.86; P < .001), and urinary collecting structures (conventional imaging, 2.76; IQR, 2.42-3.00 vs 3-D print, 3.86; IQR, 3.64-4.39; P < .001 and AR hologram, 4.00; IQR, 3.93-4.58; P < .001). There were no differences in anatomical assessment between the two 3-D techniques (the 3-D print and AR hologram). CONCLUSIONS AND RELEVANCE In this study, the 3-D kidney models were associated with improved anatomical understanding among the surgeons and can be helpful in future preoperative planning of nephron-sparing surgery for Wilms tumors. These models may be considered as a supplementary visualization in clinical care.
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Affiliation(s)
- Lianne M. Wellens
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jene Meulstee
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cornelis P. van de Ven
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Annemieke S. Littooij
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Marta Fiocco
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Division of Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
- Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Anne C. Rios
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Thomas Maal
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marc H. W. A. Wijnen
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Ottenhoff JSE, Nikkels PGJ, Terwisscha van Scheltinga CEJ, Naeije L. A Solitary Intestinal Myofibroma: A Rare Cause of Neonatal Anemia. Case Rep Oncol 2017; 10:890-896. [PMID: 29279689 PMCID: PMC5731177 DOI: 10.1159/000481305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022] Open
Abstract
Solitary infantile myofibroma with visceral involvement is very rare. We present an unusual case of a solitary myofibroma with abdominal localization in a 1-day-old female neonate who presented with severe anemia and rectal bleeding. A bleeding myofibroma was found, located in the wall of the jejunum, and totally resected. In case of a solitary lesion, treatment is relatively easy and effective, with excellent prognosis after total resection. The multiple form (myofibromatosis) has a poor prognosis with low survival rates. We therefore recommend total body MRI for all patients diagnosed with myofibroma to rule out other lesions.
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Affiliation(s)
- Janna S E Ottenhoff
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter G J Nikkels
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - L Naeije
- Department of Pediatric Oncology, Hematology and BMT, BC Children's Hospital, Vancouver, British Columbia, Canada
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