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Veluponnar D, Dashtbozorg B, Guimaraes MDS, Peeters MJTFDV, de Boer LL, Ruers TJM. Resection Ratios and Tumor Eccentricity in Breast-Conserving Surgery Specimens for Surgical Accuracy Assessment. Cancers (Basel) 2024; 16:1813. [PMID: 38791892 PMCID: PMC11119905 DOI: 10.3390/cancers16101813] [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: 04/17/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
This study aims to evaluate several defined specimen parameters that would allow to determine the surgical accuracy of breast-conserving surgeries (BCS) in a representative population of patients. These specimen parameters could be used to compare surgical accuracy when using novel technologies for intra-operative BCS guidance in the future. Different specimen parameters were determined among 100 BCS patients, including the ratio of specimen volume to tumor volume (resection ratio) with different optimal margin widths (0 mm, 1 mm, 2 mm, and 10 mm). Furthermore, the tumor eccentricity [maximum tumor-margin distance - minimum tumor-margin distance] and the relative tumor eccentricity [tumor eccentricity ÷ pathological tumor diameter] were determined. Different patient subgroups were compared using Wilcoxon rank sum tests. When using a surgical margin width of 0 mm, 1 mm, 2 mm, and 10 mm, on average, 19.16 (IQR 44.36), 9.94 (IQR 18.09), 6.06 (IQR 9.69) and 1.35 (IQR 1.78) times the ideal resection volume was excised, respectively. The median tumor eccentricity among the entire patient population was 11.29 mm (SD = 3.99) and the median relative tumor eccentricity was 0.66 (SD = 2.22). Resection ratios based on different optimal margin widths (0 mm, 1 mm, 2 mm, and 10 mm) and the (relative) tumor eccentricity could be valuable outcome measures to evaluate the surgical accuracy of novel technologies for intra-operative BCS guidance.
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Affiliation(s)
- Dinusha Veluponnar
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marcos Da Silva Guimaraes
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marie-Jeanne T. F. D. Vrancken Peeters
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lisanne L. de Boer
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Theo J. M. Ruers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
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Argacha P, Cortadellas T, Acosta J, Gonzalez-Farré X, Xiberta M. Comparison of ultrasound guided surgery and radio-guided occult lesions localization (ROLL) for nonpalpable breast cancer excision. Gland Surg 2023; 12:1233-1241. [PMID: 37842539 PMCID: PMC10570981 DOI: 10.21037/gs-23-27] [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: 01/19/2023] [Accepted: 07/20/2023] [Indexed: 10/17/2023]
Abstract
Background There is little literature comparing intraoperative ultrasound (IOUS) with radio-guided occult lesions localization (ROLL) in nonpalpable invasive tumors in breast conserving surgery (BCS). There is a need to compare these two methods in terms of safety and efficacy. Methods This is an observational cohort study. All patients treated with BCS for nonpalpable invasive breast cancer using IOUS from March 2016 to March 2020 were included and compared with a historical reference control group operated on using ROLL from March 2013 to March 2017. For each detection method, the ability to locate tumors intraoperatively, tumor and surgical specimen sizes, total resection volume (TRV), optimal resection volume, excess of healthy tissue resected (ETR), margin status, re-excision rate, surgical time, complications and costs were studied. Results One hundred and fifty-eight were included, 83 with IOUS and 75 with ROLL. The mean tumor size is equivalent in both groups (11.88 mm IOUS vs. 12.29 mm ROLL, P=0.668). TRV is significantly lower with IOUS (24.92 vs. 60.32 cm3, P<0.001), and the ETR is also significantly lower in the IOUS group (21.74 vs. 58.37 cm3, P<0.001). The rate of positive margins did not differ (10.98% vs. 12.16%, P=1), nor did re-excision rate (10.98% vs. 8.11%, P=0.597). Complication rate did not differ (12.2% IOUS vs. 10.81% ROLL, P=0.808). Surgical time was shorter in IOUS (45.5 vs. 57 min, P>0.05). Conclusions IOUS in BCS for nonpalpable invasive breast cancer is more accurate than ROLL because it decreases excision volumes with the same rate of free margins and re-excision. Also, IOUS is a more efficient and comfortable technique, and just as safe as ROLL.
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Affiliation(s)
- Paula Argacha
- Department of Breast Surgical Oncology, Hospital Universitari General de Catalunya, Dexeus, Spain
| | - Tomás Cortadellas
- Department of Breast Surgical Oncology, Hospital Universitari General de Catalunya, Dexeus, Spain
| | - Juan Acosta
- Department of Obstetrics and Ginecology, Hospital Universitari General de Catalunya, Dexeus, Spain
| | | | - Manel Xiberta
- Department of Obstetrics and Ginecology, Hospital Universitari General de Catalunya, Dexeus, Spain
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Veluponnar D, Dashtbozorg B, Jong LJS, Geldof F, Da Silva Guimaraes M, Vrancken Peeters MJTFD, van Duijnhoven F, Sterenborg HJCM, Ruers TJM, de Boer LL. Diffuse reflectance spectroscopy for accurate margin assessment in breast-conserving surgeries: importance of an optimal number of fibers. BIOMEDICAL OPTICS EXPRESS 2023; 14:4017-4036. [PMID: 37799696 PMCID: PMC10549728 DOI: 10.1364/boe.493179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 10/07/2023]
Abstract
During breast-conserving surgeries, it remains challenging to accomplish adequate surgical margins. We investigated different numbers of fibers for fiber-optic diffuse reflectance spectroscopy to differentiate tumorous breast tissue from healthy tissue ex vivo up to 2 mm from the margin. Using a machine-learning classification model, the optimal performance was obtained using at least three emitting fibers (Matthew's correlation coefficient (MCC) of 0.73), which was significantly higher compared to the performance of using a single-emitting fiber (MCC of 0.48). The percentage of correctly classified tumor locations varied from 75% to 100% depending on the tumor percentage, the tumor-margin distance and the number of fibers.
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Affiliation(s)
- Dinusha Veluponnar
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Lynn-Jade S. Jong
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Freija Geldof
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Marcos Da Silva Guimaraes
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - Frederieke van Duijnhoven
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Henricus J. C. M. Sterenborg
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Theo J. M. Ruers
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Lisanne L. de Boer
- Department of Surgery,
Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Vartanian A, Papas PV, Guarecuco Castillo JE, Sistare M, Masri MM. Ultrasound Guided Intraoperative Wire Localization Under General Anesthesia in Breast-Conserving Surgery. Cureus 2023; 15:e41662. [PMID: 37565099 PMCID: PMC10412144 DOI: 10.7759/cureus.41662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Breast-conserving surgery (BCS) is becoming an increasingly preferred surgical technique for treating breast cancer. For the last several decades, using a preoperative wire placed by a radiologist has been the gold standard to help guide surgeons to excise a suspicious mass. In recent years, there has been an increasing focus on using surgeon-performed intraoperative ultrasound (IOUS) during breast-conserving therapy, suggesting improved cosmetic outcomes and a decreased need for re-excision. However, studies have also highlighted that ultrasound may be uncomfortable for surgeons who have become most familiar with a wire-localization technique. Wire localization and intraoperative ultrasound are valuable tools that can improve the accuracy of tumor localization and reduce the need for re-excision. We present a 45-year-old female with a right breast mass, measuring breast imaging reporting and data system (BIRADS) 4A on preoperative ultrasound. Intraoperative wire-localization was performed by the surgeon utilizing ultrasound guidance. The right breast lesion was successfully excised with negative margins. The patient was discharged home and recovered well. Surgeon-performed intraoperative ultrasound can be combined with surgeon-performed wire localization to reduce the need for re-excision surgery and allow the surgeon to retain the familiarity of utilizing a gold-standard technique. Further research is needed to determine the optimal use of surgeon-performed IOUS and wire-localization, and its impact on long-term outcomes.
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Affiliation(s)
- Artin Vartanian
- General Surgery, St. George's University School of Medicine, St. George's, GRD
| | - Paraskevi V Papas
- General Surgery, St. George's University School of Medicine, St. George's, GRD
| | | | - Michael Sistare
- General Surgery, Larkin Community Hospital, South Miami, USA
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Fosko NK, Gribkova Y, Krupa K, Bs KJ, Moore D, Chen C, Potdevin L, Kumar S, Eladoumikdachi F, Kowzun MJ. The Use of Intraoperative Ultrasound During Breast Conserving Surgery. Clin Breast Cancer 2023; 23:54-59. [PMID: 36319507 DOI: 10.1016/j.clbc.2022.10.003] [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: 07/18/2022] [Accepted: 10/07/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The purpose of this study is to evaluate the utilization of intraoperative ultrasound (IOUS) for tumor localization in breast-conserving surgery and to examine its impact on margin positivity and re-excision rates. Additionally, the study seeks to identify factors contributing to surgeon utilization of IOUS. METHODS A retrospective chart review was conducted of patients with preoperative diagnosis of breast cancer undergoing breast-conserving surgery by breast surgeons at multiple centers within a single healthcare system. Characteristics such as lesion size, palpability, histology, receptor status, and use of neoadjuvant chemotherapy were recorded. Re-excision rates were determined based on localization technique and surgeons' status of breast ultrasound certification. RESULTS A total of 671 cases were performed, with 322 meeting study inclusion. 57 cases utilized IOUS, 250 utilized preoperative wire-guided localization (WGL), 10 used both methods and 5 cases used neither method. There was no significant difference in re-excision rates between IOUS and WGL or among the four surgeons. Ultrasound-certified surgeons were more likely to utilize IOUS, and re-excision rates trended higher for WGL, which may be clinically significant. CONCLUSION Increasing familiarity with and utilization of IOUS during breast-conserving surgery may be clinically advantageous over traditional localization techniques. Ultrasound certification may lead to increased use of IOUS among surgeons.
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Affiliation(s)
- Nicole K Fosko
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Kelly Krupa
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Kavita Jain Bs
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Dirk Moore
- Rutgers School of Public Health, New Brunswick, New Jersey
| | - Chunxia Chen
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Lindsay Potdevin
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Shicha Kumar
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Maria J Kowzun
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
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Redfern RE, Shermis RB. Initial Experience Using Magseed for Breast Lesion Localization Compared With Wire-Guided Localization: Analysis of Volume and Margin Clearance Rates. Ann Surg Oncol 2022; 29:3776-3783. [DOI: 10.1245/s10434-022-11327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/27/2021] [Indexed: 11/18/2022]
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Wignarajah P, Papalouka V, Forouhi P. Outcomes of intraoperative versus preoperative ultrasound-guided wire localization of nonpalpable breast lesions. BREAST CANCER MANAGEMENT 2021. [DOI: 10.2217/bmt-2020-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Nonpalpable breast lesions require localization, the gold standard for which is preoperative ultrasound-guided wire localization (PUGWL). Our unit also employs intraoperative ultrasound-guided wire localization (IUGWL). Here we evaluate PUGWL and IUGWL outcomes between 2014 and 2018. Primary outcomes were reoperation rates, complication rates and average specimen weights. Trainee feedback and cost analysis assessed IUGWL viability. Methods: Prospectively recorded data were collected. 511 patients were included (241 PUGWL and 270 IUGWL). Results: Reoperation rates: PUGWL 17.7% versus IUGWL 13.9% (p = 0.28) . Complication rates: PUGWL 5.8% versus IUGWL 6.6% (p = 0.72) . Average specimen weight: PUGWL 34.2 g versus IUGWL 24.3 g (p < 0.0001) . Trainees needed 15 supervised cases to be IUGWL competent. Performing IUGWL saves £289 per localization. Conclusion: IUGWL outcomes are comparable to those of PUGWL. IUGWL is cost-effective, patient-friendly and easy to learn and replicate. IUGWL merits wider dissemination and further planned research.
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Affiliation(s)
- Primeera Wignarajah
- Department of Breast Surgery, Cambridge Breast Unit, Addenbrookes’ Hospital, Cambridge University Hospitals Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Vasiliki Papalouka
- Department of Radiology, Cambridge Breast Unit, Addenbrookes’ Hospital, Cambridge University Hospitals Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Parto Forouhi
- Department of Breast Surgery, Cambridge Breast Unit, Addenbrookes’ Hospital, Cambridge University Hospitals Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK
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Elfgen C, Papassotiropoulos B, Varga Z, Moskovszky L, Nap M, Güth U, Baege A, Amann E, Chiesa F, Tausch C. Comparative analysis of confocal microscopy on fresh breast core needle biopsies and conventional histology. Diagn Pathol 2019; 14:58. [PMID: 31202280 PMCID: PMC6570850 DOI: 10.1186/s13000-019-0835-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022] Open
Abstract
Background Evaluation of core needle biopsies (CNB) is a standard procedure for the diagnosis of breast cancer. However, tissue processing and image preparation is a time- consuming procedure and instant on-site availability of high-quality images could substantially improve the efficacy of the diagnostic procedure. Conventional microscopic methods, such as frozen section analysis (FSA) for detection of malignant cells still have clear disadvantages. In the present study, we tested a confocal microscopy scanner on fresh tissue from CNB with intention to develop an alternative device to FSA in clinical practice. Patients and methods In 24 patients with suspicious breast lesions standard of care image-guided biopsies were performed. Confocal images have been obtained using the Histolog™ Scanner and evaluated by two independent pathologists. Hematoxylin-Eosin (H&E) histological sections of the biopsies were routinely processed in a blinded fashion with respect to the confocal images. Results In total 42 confocal images were generated from 24 biopsy specimens, and available for analysis within a few minutes of taking the biopsy. This resulted in 2 × 42 = 84 pathologic evaluations. In four cases, a pathologic diagnosis was not possible with confocal microscopy. An exact correlation based on the B-classification was reached in 41 out of 80 examinations and in another 35 cases in a broader sense of correspondence definition (i.e. malignant vs. benign). Conclusions As a reliable on-site method, the Histolog™ Scanner provides a visualization of cellular details equivalent to the H&E standards, permitting rapid and accurate diagnosis of malignant and benign breast lesions. Furthermore, this device offers great potential for immediate margin analysis of specimen in breast conserving therapy.
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Affiliation(s)
- C Elfgen
- Breast Center Zurich, Seefeldstrasse 214, 8008, Zürich, Switzerland. .,Institute of Gynecology and Obstetrics, Senology Department, University of Witten-Herdecke, Witten, Germany.
| | | | - Z Varga
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - L Moskovszky
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - M Nap
- Nap Pathology Consultance bv, Numandorp, The Netherlands
| | - U Güth
- Breast Center Zurich, Seefeldstrasse 214, 8008, Zürich, Switzerland
| | - A Baege
- Breast Center Zurich, Seefeldstrasse 214, 8008, Zürich, Switzerland
| | - E Amann
- Breast Center Zurich, Seefeldstrasse 214, 8008, Zürich, Switzerland
| | - F Chiesa
- Breast Center Zurich, Seefeldstrasse 214, 8008, Zürich, Switzerland
| | - C Tausch
- Breast Center Zurich, Seefeldstrasse 214, 8008, Zürich, Switzerland
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