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Ferrucci M, Milardi F, Passeri D, Mpungu LF, Francavilla A, Cagol M, Saibene T, Michieletto S, Toffanin M, Del Bianco P, Grossi U, Marchet A. Intraoperative Ultrasound-Guided Conserving Surgery for Breast Cancer: No More Time for Blind Surgery. Ann Surg Oncol 2023; 30:6201-6214. [PMID: 37606837 DOI: 10.1245/s10434-023-13900-x] [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: 04/21/2023] [Accepted: 06/23/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Breast-conserving surgery (BCS) still remains a blind surgery despite all available tumor localization methods. Intraoperative ultrasound (IOUS) allows real-time visualization during all resection phases. METHODS This was a prospective observational cohort study conducted at the Veneto Institute of Oncology between January 2021 and June 2022. Patients with ductal carcinoma in situ, T1-2 invasive cancer, or post-neoadjuvant tumors, suitable for BCS, were recruited. All breast cancer lesion types were included, i.e. solid palpable, solid non-palpable, non-solid non-palpable, and post-neoadjuvant treatment residual lesions. Eligible participants were randomly assigned to either IOUS or traditional surgery (TS) in a 1:1 ratio. The main outcomes were surgical margin involvement, reoperation rate, closest margin width, main specimen and cavity shaving margin volumes, excess healthy tissue removal, and calculated resection ratio (CRR). RESULTS Overall, 160 patients were enrolled: 80 patients were allocated to the TS group and 80 to the IOUS group. IOUS significantly reduced specimen volumes (16.8 cm3 [10.5-28.9] vs. 24.3 cm3 [15.0-41.3]; p = 0.015), with wider closest resection margin width (2.0 mm [1.0-4.0] vs. 1.0 mm [0.5-2.0] after TS; p < 0.001). Tumor volume to specimen volume ratio was significantly higher after IOUS (4.7% [2.5-9.1] vs. 2.9% [0.8-5.2]; p < 0.001). IOUS yielded significantly better CRR (84.5% [46-120.8] vs. 114% [81.8-193.2] after TS; p < 0.001), lower involved margin rate (2.5 vs. 15%; p = 0.009) and reduced re-excision rate (2.5 vs. 12.5%; p = 0.032). CONCLUSIONS IOUS allows real-time resection margin visualization and continuous control during BCS. It showed clear superiority over TS in both oncological and surgical outcomes for all breast cancer lesion types. These results disfavor the paradigm of blind breast surgery.
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Affiliation(s)
- Massimo Ferrucci
- Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy.
| | - Francesco Milardi
- General Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Daniele Passeri
- General Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | | | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, Department of CardiacThoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Cagol
- Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Tania Saibene
- Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Silvia Michieletto
- Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Mariacristina Toffanin
- Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Paola Del Bianco
- Clinical Trials and Biostatistics, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Ugo Grossi
- General Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Alberto Marchet
- Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
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Walker E, Linders DGJ, Abenojar E, Wang X, Hazelbag HM, Straver ME, Bijlstra OD, March TL, Vahrmeijer AL, Exner A, Bogyo M, Basilion JP, Straight B. Formulation of a Thermosensitive Imaging Hydrogel for Topical Application and Rapid Visualization of Tumor Margins in the Surgical Cavity. Cancers (Basel) 2022; 14:cancers14143459. [PMID: 35884520 PMCID: PMC9323389 DOI: 10.3390/cancers14143459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023] Open
Abstract
Simple Summary We have developed a formulation for an innovative, quenched, cathepsin-targeted, fluorescent molecular probe to enhance resection quality for several solid-tumor cancers. Unlike other formulations for imaging probes or tracers in development and entering the clinic, which require systemic administration hours before the procedure, this current formulation is applied topically into the surgical cavity immediately after a standard of care resection. Within minutes of application, the probe activates in the presence of residual cancer in the surgical wound and provides a strong fluorescent signal that precisely delineates any remaining cancer, enabling a more complete resection. Utilization of this imaging gel formulation for topical application to detect breast cancer in the surgical cavity during surgery has the potential to reduce re-excisions, with consequent savings in healthcare costs and enhancement in patient quality of life. Abstract Background: Tumor-positive surgical margins during primary breast cancer (BCa) surgery are associated with a two-fold increase in the risk of local recurrence when compared with tumor-negative margins. Pathological microscopic evaluation of the samples only assesses about 1/10 of 1% of the entire volume of the removed BCa specimens, leading to margin under-sampling and potential local recurrence in patients with pathologically clean margins, i.e., false negative margins. In the case of tumor-positive margins, patients need to undergo re-excision and/or radiation therapy, resulting in increases in complications, morbidity, and healthcare costs. Development of a simple real-time imaging technique to identify residual BCa in the surgical cavity rapidly and precisely could significantly improve the quality of care. Methods: A small-molecule, fluorescently quenched protease-substrate probe, AKRO-QC-ICG, was tested as part of a thermosensitive imaging gel formulated for topical application and imaging of the BCa surgical cavity. Results: More than forty formulations of gel mixtures were investigated to enable easy fluid application and subsequent solidification once applied, preventing dripping and pooling in the surgical cavity. The final formulation was tested using human BCa orthotopic implants in nude and NSG patient-derived xenografts (PDX) mice. This formulation of Pluronic F-127/DMSO/AKRO-QC-ICG imaging gel was found to be a good solvent for the probe, with a desirable thermo-reversible solid–gel transition and mechanical strength for distribution of AKRO-QC-ICG on the surfaces of tissue. It demonstrated excellent ability to detect BCa tissue after 10 min exposure, with a high signal-to-noise ratio both in mouse xenografts and freshly excised human lumpectomy tissue. The in vivo efficacy of the AKRO-QC-ICG imaging gel to detect BCa revealed the levels of sensitivity/specificity = 0.92/1 in 12 nude mice, which was corroborated with the sensitivity/specificity = 0.94/1 in 10 PDX mice. Conclusions: Utilization of Pluronic F-127/DMSO/AKRO-QC-ICG imaging gel for topical application to detect BCa in the surgical cavity during surgery has the potential to reduce re-excisions, with consequent savings in healthcare costs and enhancement in patient quality of life.
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Affiliation(s)
- Ethan Walker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (E.W.); (X.W.); (A.E.); (J.P.B.)
| | - Daan G. J. Linders
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.G.J.L.); (O.D.B.); (A.L.V.)
| | - Eric Abenojar
- Department of Radiology, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Xinning Wang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (E.W.); (X.W.); (A.E.); (J.P.B.)
| | - Hans Marten Hazelbag
- Department of Pathology, Haaglanden Medical Center, 2512 VA The Hague, The Netherlands;
| | - Marieke E. Straver
- Department of Surgery, Haaglanden Medical Center, 2512 VA The Hague, The Netherlands;
| | - Okker D. Bijlstra
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.G.J.L.); (O.D.B.); (A.L.V.)
| | - Taryn L. March
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Alexander L. Vahrmeijer
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.G.J.L.); (O.D.B.); (A.L.V.)
| | - Agata Exner
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (E.W.); (X.W.); (A.E.); (J.P.B.)
- Department of Radiology, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Matthew Bogyo
- Department of Pathology, Stanford University, Stanford, CA 94305, USA;
- Department of Microbiology and Immunology, Stanford University, Stanford, CA 94305, USA
| | - James P. Basilion
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (E.W.); (X.W.); (A.E.); (J.P.B.)
- Department of Radiology, Case Western Reserve University, Cleveland, OH 44106, USA;
- Akrotome Imaging Inc., Charlotte, NC 28205, USA
| | - Brian Straight
- Akrotome Imaging Inc., Charlotte, NC 28205, USA
- Correspondence: ; Tel.: +1-216-983-3264
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Li W, Li X. Development of intraoperative assessment of margins in breast conserving surgery: a narrative review. Gland Surg 2022; 11:258-269. [PMID: 35242687 PMCID: PMC8825505 DOI: 10.21037/gs-21-652] [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: 09/19/2021] [Accepted: 11/17/2021] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We intend to provide an informative and up-to-date summary on the topic of intraoperative assessment of margins in breast conserving surgery (BCS). Conventional methods as well as cutting-edge technologies are analyzed for their advantages and limitations in the hope that clinicians can turn to this for reference. This review can also offer guidance for technicians in the future design of intraoperative margin assessment tools. BACKGROUND Achieving negative margins during BCS is one of the vital factors for preventing local recurrence. Conducting intraoperative margin assessment can ensure negative margins to a large extent and possibly relieve patients of the anguish of re-interventions. In recent years, innovative methods for margin assessment during BCS are advancing rapidly. And there is a lack of summary regarding the development of intraoperative margin assessment in BCS. METHODS A PubMed search with keywords "intraoperative margin assessment" and "breast conserving surgery" was conducted. Relevant publications were screened manually for its title, abstract and even full text to determine its true relevance. Publications on neo-adjuvant therapy and intraoperative radiotherapy were excluded. References from the searched articles and other supplementary articles were also looked into. CONCLUSIONS Conventional methods for margin assessment yields stable outcome but its use is limited because of the demand on pathology staff and the trade-off between time and precision. Conventional imaging techniques pass the workload to radiologists at the cost of a significantly low duration of time. Involving artificial intelligence for image-based assessment is a further improvement. However, conventional imaging is inherently flawed in that occult lesions can't show on the image and the showing ones are ambiguous and open to interpretation. Unconventional techniques which base their judgment on cellular composition are more reassuring. Nonetheless, unconventional techniques should be subjected to clinical trials before putting into practice. And studies regarding comparison between conventional methods and unconventional methods are also needed to evaluate their relative efficacy.
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Affiliation(s)
- Wanheng Li
- First Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Xiru Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Baliski C, Jay M, Hamm J. Intraoperative ultrasound is associated with low re-excision rates following breast conserving surgery for non-palpable invasive breast cancers. Am J Surg 2021; 221:1164-1166. [PMID: 33840447 DOI: 10.1016/j.amjsurg.2021.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/12/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Wire localized breast biopsy (WLB) is the most commonly performed procedure for the removal of non-palpable breast cancer. It is associated with patient discomfort and high re-excision rates. Intraoperative ultrasound (IOUS) is an alternative technique that may improve patient experience and have lower re-excision rates. METHODS A retrospective, single surgeon experience with IOUS is compared with WLB. Case matching for variables known to impact re-excision rates is performed. Fisher's exact test was performed for categorical variables, and a T-test for continuous variables. RESULTS 28 patients underwent IOUS and WLB. Re-excision rates were the same in patients undergoing IOUS and WLB (10.7% vs 0%; p = 0.24). The calculated resection ratio was lower with IOUS than WLB (2.99 vs 3.46; p = 0.37), but did not reach statistical significance. CONCLUSION In selected patients, intra-operative ultrasound can be performed with a favourable re-excision rate, and comparable amounts of tissue compared to wire localized breast biopsy.
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Affiliation(s)
- Christopher Baliski
- BC Cancer-Kelowna, Dept. of Surgical Oncology, Kelowna, BC, Canada; UBC Department of Surgery, Kelowna and Vancouver, BC, Canada.
| | - Michael Jay
- Northern Medical Program, University of Northern British Columbia, Prince George, BC, Canada
| | - Jeremy Hamm
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver, BC, Canada
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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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Franceschini G, Mason EJ, Grippo C, D’Archi S, D’Angelo A, Scardina L, Sanchez AM, Conti M, Trombadori C, Terribile DA, Di Leone A, Carnassale B, Belli P, Manfredi R, Masetti R. Image-Guided Localization Techniques for Surgical Excision of Non-Palpable Breast Lesions: An Overview of Current Literature and Our Experience with Preoperative Skin Tattoo. J Pers Med 2021; 11:jpm11020099. [PMID: 33557072 PMCID: PMC7913802 DOI: 10.3390/jpm11020099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 01/14/2023] Open
Abstract
Breast conserving surgery has become the standard of care and is more commonly performed than mastectomy for early stage breast cancer, with recent studies showing equivalent survival and lower morbidity. Accurate preoperative lesion localization is mandatory to obtain adequate oncological and cosmetic results. Image guidance assures the precision requested for this purpose. This review provides a summary of all techniques currently available, ranging from the classic wire positioning to the newer magnetic seed localization. We describe the procedures and equipment necessary for each method, outlining the advantages and disadvantages, with a focus on the cost-effective preoperative skin tattoo technique performed at our centre. Breast surgeons and radiologists have to consider ongoing technological developments in order to assess the best localization method for each individual patient and clinical setting.
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Affiliation(s)
- Gianluca Franceschini
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Elena Jane Mason
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
- Correspondence: ; Tel.: +39-33-5700-4572
| | - Cristina Grippo
- Dipartimento di Diagnostica per Immagini, Radiologia Terapeutica ed Interventistica, Azienda Ospedaliera Santa Maria Terni, 05100 Terni, Italy;
| | - Sabatino D’Archi
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Anna D’Angelo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Lorenzo Scardina
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Marco Conti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Charlotte Trombadori
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Daniela Andreina Terribile
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alba Di Leone
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Beatrice Carnassale
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
| | - Paolo Belli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.D.); (M.C.); (C.T.); (P.B.); (R.M.)
| | - Riccardo Masetti
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.); (S.D.); (L.S.); (A.M.S.); (D.A.T.); (A.D.L.); (B.C.); (R.M.)
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Hu X, Li S, Jiang Y, Wei W, Ji Y, Li Q, Jiang Z. Intraoperative ultrasound-guided lumpectomy versus wire-guided excision for nonpalpable breast cancer. J Int Med Res 2020; 48:300060519896707. [PMID: 31937169 PMCID: PMC7113704 DOI: 10.1177/0300060519896707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective This study was designed to compare the margin clearance and re-excision rates of ultrasound (US)- and wire-guided excision in a large number of patients with nonpalpable breast cancer. Methods In total, 520 women who were histologically diagnosed with nonpalpable breast cancer were recruited in this study. All nonpalpable lesions were visible by US. The patients were randomly divided into two groups: those who underwent wire-guided breast-conserving surgery (BCS) and those who underwent US-guided BCS. Re-excision rates and positive surgical margins were recorded. Results A total of 262 patients underwent US-guided excision and 258 patients underwent wire-guided excision. No differences were found in tumor or patient characteristics. The positive margin rate was 4.6% in the US-guided group and 19.4% in the wire-guided group with a significant difference. Age, menopausal status, excision volume, histological grade, and tumor type significantly influenced the positive surgical margin rate. The intraoperative re-excision rate was significantly lower in the US-guided group than wire-guided group (11.1% vs. 24.0%, respectively). Conclusions US-guided BCS seems to be more effective than wire-guided BCS for treatment of nonpalpable breast cancers in terms of the margin clearance and re-excision rates. Patients can avoid the discomfort caused by preoperative wire placement.
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Affiliation(s)
- Xin Hu
- Department of Pain Management, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Si Li
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yi Jiang
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wei Wei
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yinan Ji
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qiuyun Li
- Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zongbin Jiang
- Department of Pain Management, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Barba D, León-Sosa A, Lugo P, Suquillo D, Torres F, Surre F, Trojman L, Caicedo A. Breast cancer, screening and diagnostic tools: All you need to know. Crit Rev Oncol Hematol 2020; 157:103174. [PMID: 33249359 DOI: 10.1016/j.critrevonc.2020.103174] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/18/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is one of the most frequent malignancies among women worldwide. Methods for screening and diagnosis allow health care professionals to provide personalized treatments that improve the outcome and survival. Scientists and physicians are working side-by-side to develop evidence-based guidelines and equipment to detect cancer earlier. However, the lack of comprehensive interdisciplinary information and understanding between biomedical, medical, and technology professionals makes innovation of new screening and diagnosis tools difficult. This critical review gathers, for the first time, information concerning normal breast and cancer biology, established and emerging methods for screening and diagnosis, staging and grading, molecular and genetic biomarkers. Our purpose is to address key interdisciplinary information about these methods for physicians and scientists. Only the multidisciplinary interaction and communication between scientists, health care professionals, technical experts and patients will lead to the development of better detection tools and methods for an improved screening and early diagnosis.
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Affiliation(s)
- Diego Barba
- Escuela de Medicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Mito-Act Research Consortium, Quito, Ecuador
| | - Ariana León-Sosa
- Escuela de Medicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Mito-Act Research Consortium, Quito, Ecuador
| | - Paulina Lugo
- Hospital de los Valles HDLV, Quito, Ecuador; Fundación Ayuda Familiar y Comunitaria AFAC, Quito, Ecuador
| | - Daniela Suquillo
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Mito-Act Research Consortium, Quito, Ecuador; Ingeniería en Procesos Biotecnológicos, Colegio de Ciencias Biológicas y Ambientales COCIBA, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Fernando Torres
- Escuela de Medicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Hospital de los Valles HDLV, Quito, Ecuador
| | - Frederic Surre
- University of Glasgow, James Watt School of Engineering, Glasgow, G12 8QQ, United Kingdom
| | - Lionel Trojman
- LISITE, Isep, 75006, Paris, France; Universidad San Francisco de Quito USFQ, Colegio de Ciencias e Ingenierías Politécnico - USFQ, Instituto de Micro y Nanoelectrónica, IMNE, USFQ, Quito, Ecuador
| | - Andrés Caicedo
- Escuela de Medicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Mito-Act Research Consortium, Quito, Ecuador; Sistemas Médicos SIME, Universidad San Francisco de Quito USFQ, Quito, Ecuador.
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9
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Sanderson RW, Fang Q, Curatolo A, Adams W, Lakhiani DD, Ismail HM, Foo KY, Dessauvagie BF, Latham B, Yeomans C, Saunders CM, Kennedy BF. Camera-based optical palpation. Sci Rep 2020; 10:15951. [PMID: 32994500 PMCID: PMC7524728 DOI: 10.1038/s41598-020-72603-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/28/2020] [Indexed: 12/25/2022] Open
Abstract
Optical elastography is undergoing extensive development as an imaging tool to map mechanical contrast in tissue. Here, we present a new platform for optical elastography by generating sub-millimetre-scale mechanical contrast from a simple digital camera. This cost-effective, compact and easy-to-implement approach opens the possibility to greatly expand applications of optical elastography both within and beyond the field of medical imaging. Camera-based optical palpation (CBOP) utilises a digital camera to acquire photographs that quantify the light intensity transmitted through a silicone layer comprising a dense distribution of micro-pores (diameter, 30-100 µm). As the transmission of light through the micro-pores increases with compression, we deduce strain in the layer directly from intensity in the digital photograph. By pre-characterising the relationship between stress and strain of the layer, the measured strain map can be converted to an optical palpogram, a map of stress that visualises mechanical contrast in the sample. We demonstrate a spatial resolution as high as 290 µm in CBOP, comparable to that achieved using an optical coherence tomography-based implementation of optical palpation. In this paper, we describe the fabrication of the micro-porous layer and present experimental results from structured phantoms containing stiff inclusions as small as 0.5 × 0.5 × 1 mm. In each case, we demonstrate high contrast between the inclusion and the base material and validate both the contrast and spatial resolution achieved using finite element modelling. By performing CBOP on freshly excised human breast tissue, we demonstrate the capability to delineate tumour from surrounding benign tissue.
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Affiliation(s)
- Rowan W Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, WA, 6009, Australia. .,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, WA, 6009, Australia.
| | - Qi Fang
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, WA, 6009, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Andrea Curatolo
- Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, WA, 6009, Australia.,Visual Optics and Biophotonics Group, Instituto de Óptica "Daza de Valdés", Consejo Superior de Investigaciones Científicas (IO, CSIC), C/Serrano, 121, Madrid, Spain
| | - Wayne Adams
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, WA, 6009, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Devina D Lakhiani
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, WA, 6009, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Hina M Ismail
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, WA, 6009, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, WA, 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, WA, 6009, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Benjamin F Dessauvagie
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA, 6150, Australia.,Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA, 6150, Australia.,The University of Notre Dame, Fremantle, WA, 6160, Australia
| | - Chris Yeomans
- PathWest, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA, 6150, Australia
| | - Christobel M Saunders
- Division of Surgery, Medical School, The University of Western Australia, Crawley, WA, 6009, Australia.,Breast Centre, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA, 6150, Australia.,Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, WA, 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, WA, 6009, Australia.,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, Crawley, WA, 6009, Australia.,Australian Research Council Centre for Personalised Therapeutics Technologies, Melbourne, Australia
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10
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Layeequr Rahman R, Puckett Y, Habrawi Z, Crawford S. A decade of intraoperative ultrasound guided breast conservation for margin negative resection - Radioactive, and magnetic, and Infrared Oh My…. Am J Surg 2020; 220:1410-1416. [PMID: 32958157 DOI: 10.1016/j.amjsurg.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/11/2020] [Accepted: 09/03/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The oncologic goal of margin-negative breast conservation requires adequate localization of tumor. Intraoperative ultrasound remains most feasible but under-utilized method to localize the tumor and assess margins. METHODS A prospectively maintained breast cancer database over a decade was queried for margin status in breast cancer patients undergoing breast conservation. Techniques of tumor localization, margin re-excision and closest margins were analyzed. Rate of conversion to mastectomy was determined. RESULTS Of the 945 breast cancer patients treated at a university-based Breast Center of Excellence between January 1, 2009 and December 31, 2018, 149(15.8%) had ductal carcinoma in situ; 712(75.3%) had invasive ductal carcinoma, and 63(6.7%) had invasive lobular carcinoma. Clinical stage distribution was: T1 = 372(39.4%); T2 = 257(27.2%); T3 = 87(9.2%). Five hundred and eighty three (61.7%) patients underwent breast conservation. The median (25th -75th centile) closest margin was 6(2.5, 10.0) mm. Thirty five (6.0%) patients underwent margin re-excision, of which 9(25%) were converted to mastectomy. Tumor localization was achieved with ultrasound in 521(89.4%) patients and with wire localization in 62(10.6%) patients. The median (25th-75th centile) closest margin with wire localization was 5.0(2.0, 8.5) mm versus 5.0 (2.0, 8.0) mm with ultrasound guidance [p = 0.6635]. The re-excision rate with wire localization was 14.5% versus 4.9% with ultrasound guidance [p = 0.0073]. The unadjusted Odds Ratio (95% CI) for margin revision in wire localized group compared with ultrasound was 3.2 (7.14, 1.42) [p = 0.0045]; multivariate adjusted OR (95%) was 4(9.09, 1.7) [p = 0.0013]. CONCLUSIONS Ultrasound guidance for localization of breast cancer remains the most effective option for margin negative breast conservation.
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Affiliation(s)
- Rakhshanda Layeequr Rahman
- Texas Tech University Health Sciences Center, Department of Surgery, MS 8312, 3601 Fourth Street Lubbock, Texas, 79430, USA.
| | - Yana Puckett
- Texas Tech University Health Sciences Center, Department of Surgery, MS 8312, 3601 Fourth Street Lubbock, Texas, 79430, USA.
| | - Zaina Habrawi
- Texas Tech University Health Sciences Center, Department of Surgery, MS 8312, 3601 Fourth Street Lubbock, Texas, 79430, USA.
| | - Sybil Crawford
- University of Massachusetts, Medical School Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Shaw Building Room 228, Worcester, Massachusetts, 01655, USA.
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11
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Civil YA, Duvivier KM, Perin P, Baan AH, van der Velde S. Optimization of Wire-guided Technique With Bracketing Reduces Resection Volumes in Breast-conserving Surgery for Early Breast Cancer. Clin Breast Cancer 2020; 20:e749-e756. [PMID: 32653472 DOI: 10.1016/j.clbc.2020.04.013] [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: 03/17/2020] [Accepted: 04/26/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Wire-guided localization (WGL) of early breast cancer can be facilitated using multiple wires, which is called bracketing wire-guided localization (BWL). The primary aim of this study is to compare BWL and conventional WGL regarding minimization of resection volumes without compromising margin status. Secondly, BWL is evaluated as an alternative method for intraoperative ultrasound (US) guidance in poorly definable breast tumors on US. PATIENTS AND METHODS In this retrospective cohort study, patients with preoperatively diagnosed breast cancer undergoing wide local excision between January 2016 and December 2018 were analyzed. Patients with multifocal disease or neoadjuvant treatment were excluded from this study. Optimal resection with minimal healthy breast tissue removal was assessed using the calculated resection ratio (CRR). RESULTS BWL was performed in 17 (9%) patients, WGL in 44 (22%), and US in 139 (70%). The rate of negative margins was comparable in all 3 groups. The CRR was significantly smaller for BWL (0.6) than WGL (1.3) in tumors larger than 1.5 cm. Additionally, BWL (0.8) led to smaller CRRs than US (1.7). This could be explained by the high number of small tumors (≤ 1.5 cm) in the US group for which greater CRRs are obtained than for large tumors (> 1.5 cm) (1.9 vs. 1.4; P = .005). CONCLUSION For breast tumors larger than 1.5 cm, BWL achieves more optimal resection volumes without compromising margin status compared with WGL. Moreover, BWL seems a suitable alternative to US in patients with poorly ultrasound-visible breast tumors and patients with a small tumor in a (large) breast.
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Affiliation(s)
- Yasmin A Civil
- Department of Surgical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Katya M Duvivier
- Department of Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paola Perin
- Department of Surgery, Ziekenhuis Amstelland, Amstelveen, The Netherlands
| | - Astrid H Baan
- Department of Surgery, Ziekenhuis Amstelland, Amstelveen, The Netherlands
| | - Susanne van der Velde
- Department of Surgical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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12
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Konen J, Murphy S, Berkman A, Ahern TP, Sowden M. Intraoperative Ultrasound Guidance With an Ultrasound-Visible Clip: A Practical and Cost-effective Option for Breast Cancer Localization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:911-917. [PMID: 31737930 DOI: 10.1002/jum.15172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/14/2019] [Accepted: 10/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES In partial mastectomy (PM) or lumpectomy, ultrasound (US) localization avoids discomfort and additional procedures associated with wire localization. The purpose of this study was to evaluate the association between ultrasound-visible clip (UVC) use at the time of biopsy and US use during resection, hypothesizing that UVCs facilitate US localization and reduce costs compared with traditional radiopaque clips or no clip placement. METHODS The study population consisted of adult female patients with breast cancer undergoing PM or lumpectomy at our institution between 2014 and 2016. The core biopsy clip type and localization method during PM were characterized as wire localization versus US localization, and associations were estimated with multivariable regression models. For the cost evaluation, breast biopsy data were obtained from the Department of Radiology. RESULTS Among 674 patients, 490 had data on localization and the clip type. Ultrasound-visible clip placement at biopsy increased US use during resection by 13% (95% confidence interval, 6%-21%). There was no difference in the total specimen weight with US versus wire localization. The cost savings for using UVCs for the 2209 patients who underwent breast biopsy from 2014 to 2016 was $36,000. CONCLUSIONS This study demonstrates that US localization for PM is feasible at a single institution and cost-effective when facilitated by UVCs. Placement of a UVC at the time of biopsy is recommended, as it is cost-effective and avoids the discomfort and inconvenience of wire localization.
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Affiliation(s)
- John Konen
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Serena Murphy
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Amy Berkman
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Thomas P Ahern
- Division of Surgical Research, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Michelle Sowden
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
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13
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Esgueva A, Rodríguez-Revuelto R, Espinosa-Bravo M, Salazar JP, Rubio IT. Learning curves in intraoperative ultrasound guided surgery in breast cancer based on complete breast cancer excision and no need for second surgeries. Eur J Surg Oncol 2019; 45:578-583. [DOI: 10.1016/j.ejso.2019.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/11/2018] [Accepted: 01/11/2019] [Indexed: 01/05/2023] Open
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14
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Intraoperative ultrasound in breast cancer surgery-from localization of non-palpable tumors to objectively measurable excision. World J Surg Oncol 2018; 16:184. [PMID: 30205823 PMCID: PMC6134720 DOI: 10.1186/s12957-018-1488-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/05/2018] [Indexed: 01/08/2023] Open
Abstract
Background The utilization of intraoperative ultrasound (IOUS) in breast cancer surgery is a relatively new concept in surgical oncology. Over the last few decades, the field of breast cancer surgery has been striving for a more rational approach, directing its efforts towards removing the tumor entirely yet sparing tissue and structures not infiltrated by tumor cells. Further progress in objectivity and optimization of breast cancer excision is possible if we make the tumor and surrounding tissue visible and measurable in real time, during the course of the operation; IOUS seems to be the optimal solution to this complex requirement. IOUS was introduced into clinical practice as a device for visualization of non-palpable tumors, and compared to wire-guided localization (WGL), IOUS was always at least a viable, or much better alternative, in terms of both precision in identification and resection and for patients’ and surgeons’ comfort. In recent years, intraoperative ultrasound has been used in the surgery of palpable tumors to optimize resection procedures and overcome the disadvantages of classic palpation guided surgery. Objective The aim of this review is to show the role of IOUS in contemporary breast cancer surgery and its changes over time. Methods A PubMed database comprehensive search was conducted to identify all relevant articles according to assigned key words. Conclusion Over time, the use of IOUS has been transformed from being the means of localizing non-palpable lesions to an instrument yielding a reduced number of positive resection margins, with a smaller volume of healthy breast tissue excided around tumor, by making the excision of the tumor optimal and objectively measurable.
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15
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Merrill AY, Ochoa D, Klimberg VS, Hill EL, Preston M, Neisler K, Henry-Tillman RS. Cutting Healthcare Costs with Hematoma-Directed Ultrasound-Guided Breast Lumpectomy. Ann Surg Oncol 2018; 25:3076-3081. [DOI: 10.1245/s10434-018-6596-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Indexed: 12/28/2022]
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16
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Siso C, de Torres J, Esgueva-Colmenarejo A, Espinosa-Bravo M, Rus N, Cordoba O, Rodriguez R, Peg V, Rubio IT. Intraoperative Ultrasound-Guided Excision of Axillary Clip in Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Therapy (ILINA Trial). Ann Surg Oncol 2018; 25:784-791. [DOI: 10.1245/s10434-017-6270-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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17
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Struk S, Honart JF, Qassemyar Q, Leymarie N, Sarfati B, Alkhashnam H, Mazouni C, Rimareix F, Kolb F. Utilisation du vert d’indocyanine en chirurgie sénologique et reconstruction mammaire. ANN CHIR PLAST ESTH 2018; 63:54-61. [DOI: 10.1016/j.anplas.2017.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/25/2017] [Indexed: 12/21/2022]
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18
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Reyna C, DeSnyder SM. Intraoperative Margin Assessment in Breast Cancer Management. Surg Oncol Clin N Am 2018; 27:155-165. [DOI: 10.1016/j.soc.2017.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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19
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Arko D, Čas Sikošek N, Kozar N, Sobočan M, Takač I. The value of ultrasound-guided surgery for breast cancer. Eur J Obstet Gynecol Reprod Biol 2017; 216:198-203. [DOI: 10.1016/j.ejogrb.2017.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/16/2022]
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20
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Karadeniz Cakmak G, Emre AU, Tascilar O, Bahadir B, Ozkan S. Surgeon performed continuous intraoperative ultrasound guidance decreases re-excisions and mastectomy rates in breast cancer. Breast 2017; 33:23-28. [DOI: 10.1016/j.breast.2017.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/11/2016] [Accepted: 02/22/2017] [Indexed: 01/14/2023] Open
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21
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Gunn J, McLaughlin S. Current Trends in Localization Techniques for Non-palpable Breast Lesions: Making the Invisible Visible. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0244-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Gray RJ, Pockaj BA, Garvey E, Blair S. Intraoperative Margin Management in Breast-Conserving Surgery: A Systematic Review of the Literature. Ann Surg Oncol 2017; 25:18-27. [PMID: 28058560 DOI: 10.1245/s10434-016-5756-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast surgeons have a wide variety of intraoperative techniques available to help achieve low rates for positive margins of excision, with variable levels of evidence. METHODS A systematic review of the medical literature from 1995 to July 2016 was conducted, with 434 abstracts identified and evaluated. The analysis included 106 papers focused on intraoperative management of breast cancer margins and contained actionable data. RESULTS Ultrasound-guided lumpectomy for palpable tumors, as an alternative to palpation guidance, can lower positive margin rates, but the effect when used as an alternative to wire localization (WL) for nonpalpable tumors is less certain. Localization techniques such as radioactive seed localization and radioguided occult lesion localization were found potentially to lower positive margin rates as alternatives to WL depending on baseline positive margin rates. Intraoperative pathologic methods including gross histology, frozen section analysis, and imprint cytology all have the potential to lower the rates of positive margins. Cavity-shave margins and the Marginprobe device both lower rates of positive margins, with some potential for negative cosmetic effects. Specimen radiography and multiple miscellaneous techniques did not affect positive margin rates or provided too little evidence for formation of a conclusion. CONCLUSIONS A systematic review of the literature showed evidence that several intraoperative techniques and actions can lower the rates of positive margins. These results are presented together with graded recommendations.
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Affiliation(s)
| | | | - Erin Garvey
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Sarah Blair
- UCSD Department of Surgery, UCSD Cancer Center, Encinitas, USA
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23
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Liu J, Guo W, Tong M. Intraoperative indocyanine green fluorescence guidance for excision of nonpalpable breast cancer. World J Surg Oncol 2016; 14:266. [PMID: 27756411 PMCID: PMC5070155 DOI: 10.1186/s12957-016-1014-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 10/03/2016] [Indexed: 01/28/2023] Open
Abstract
Background Different techniques have been used for the guidance of nonpalpable breast cancer (NBC), but none of them has yet achieved perfect results. The aim of this study was to evaluate the feasibility of indocyanine green (ICG) fluorescence-guided nonpalpable breast cancer lesion excision (IFNLE), to introduce an alternative technique. Methods The data about 56 patients with preoperatively diagnosed NBCs operated with the help of intraoperative IFNLE between November of 2010 and September of 2014 were retrospectively analyzed. Results ICG fluorescence localized all lesions at surgery. Re-excision due to positive resection margins was necessary in two patients (3.6 %; 2/56) with ductal carcinoma in situ (DCIS) at the surgical margins. Mastectomy was necessary in one patient (1.8 %; 1/56) due to multifocal invasive carcinoma. The mean volume of the excised tissue was 38.2 ± 16.5 cm3. Conclusions IFNLE is a technically applicable and clinically acceptable procedure whenever a breast cancer needs image-guided excision.
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Affiliation(s)
- Jintao Liu
- Department of Surgery, The Breast Center, Dalian Central Hospital, Dalian Medical University, No. 826, Xinan Road, Shahekou District, Dalian, 116033, China
| | - Wenbin Guo
- Department of Surgery, The Breast Center, Dalian Central Hospital, Dalian Medical University, No. 826, Xinan Road, Shahekou District, Dalian, 116033, China.
| | - Meng Tong
- Department of Surgery, The Breast Center, Dalian Central Hospital, Dalian Medical University, No. 826, Xinan Road, Shahekou District, Dalian, 116033, China
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Gentile LF, Himmler A, Shaw CM, Bouton A, Vorhis E, Marshall J, Spiguel LRP. Ultrasound-Guided Segmental Mastectomy and Excisional Biopsy Using Hydrogel-Encapsulated Clip Localization as an Alternative to Wire Localization. Ann Surg Oncol 2016; 23:3284-9. [DOI: 10.1245/s10434-016-5325-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 01/22/2023]
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25
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Espinosa-Bravo M, Rubio IT. Intraoperative ultrasound guided breast surgery: paving the way for personalized surgery. Gland Surg 2016; 5:366-8. [PMID: 27294242 DOI: 10.21037/gs.2016.03.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Martin Espinosa-Bravo
- Breast Surgical Oncology, Breast Cancer Center, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Isabel T Rubio
- Breast Surgical Oncology, Breast Cancer Center, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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26
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Volders JH, Haloua MH, Krekel NMA, Meijer S, van den Tol PM. Current status of ultrasound-guided surgery in the treatment of breast cancer. World J Clin Oncol 2016; 7:44-53. [PMID: 26862490 PMCID: PMC4734937 DOI: 10.5306/wjco.v7.i1.44] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/02/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing “blind” surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast tumours in the search for better oncological and cosmetic outcomes.
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Karanlik H, Ozgur I, Sahin D, Fayda M, Onder S, Yavuz E. Intraoperative ultrasound reduces the need for re-excision in breast-conserving surgery. World J Surg Oncol 2015; 13:321. [PMID: 26596699 PMCID: PMC4657358 DOI: 10.1186/s12957-015-0731-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/06/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate ultrasound-guided surgery for palpable breast cancer by comparing the standard palpation-guided surgery in terms of the extent of healthy breast tissue resection, the percentage of tumor-free margins, and cosmetic outcomes. METHODS This was a prospective, observational cohort study conducted from January 2009 to July 2011. Breast cancer patients, diagnosed via biopsy, were operated in guidance with either ultrasound or palpation. Patient demographics, tumor features, intraoperative findings, pathologic and cosmetic results, intraoperative-measured ultrasound margins, and pathology margins were compared. RESULTS Ultrasound (US)-guided lumpectomy was performed on 84 women and palpation-guided lumpectomy on 80 women. Patient demographics and tumor characteristics showed no differences. The rate of re-excision was 17 % for the palpation-guided surgery group, and 6 % for the US-guided group (p = 0.03). There was good correlation between the closest margins recorded by US and pathology margins (r = 0.76, p = 0.01). Volume of resection was significantly larger in the palpation-guided group despite the similar size of tumors (p = 0.048). Cosmetic outcome of surgery was equivalent between groups. CONCLUSIONS Intraoperative ultrasound guidance for excision of palpable breast cancers is feasible and gives results in terms of pathologic margins that are comparable with those achieved by standard palpation-guided excisions.
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Affiliation(s)
- Hasan Karanlik
- Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey.
| | - Ilker Ozgur
- Department of General Surgery, Acibadem International Hospital, Bakirkoy, Istanbul, Turkey
| | - Dilek Sahin
- Department of Radiology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Merdan Fayda
- Department of Radiation Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ekrem Yavuz
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Kennedy KM, Chin L, McLaughlin RA, Latham B, Saunders CM, Sampson DD, Kennedy BF. Quantitative micro-elastography: imaging of tissue elasticity using compression optical coherence elastography. Sci Rep 2015; 5:15538. [PMID: 26503225 PMCID: PMC4622092 DOI: 10.1038/srep15538] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/28/2015] [Indexed: 01/22/2023] Open
Abstract
Probing the mechanical properties of tissue on the microscale could aid in the identification of diseased tissues that are inadequately detected using palpation or current clinical imaging modalities, with potential to guide medical procedures such as the excision of breast tumours. Compression optical coherence elastography (OCE) maps tissue strain with microscale spatial resolution and can delineate microstructural features within breast tissues. However, without a measure of the locally applied stress, strain provides only a qualitative indication of mechanical properties. To overcome this limitation, we present quantitative micro-elastography, which combines compression OCE with a compliant stress sensor to image tissue elasticity. The sensor consists of a layer of translucent silicone with well-characterized stress-strain behaviour. The measured strain in the sensor is used to estimate the two-dimensional stress distribution applied to the sample surface. Elasticity is determined by dividing the stress by the strain in the sample. We show that quantification of elasticity can improve the ability of compression OCE to distinguish between tissues, thereby extending the potential for inter-sample comparison and longitudinal studies of tissue elasticity. We validate the technique using tissue-mimicking phantoms and demonstrate the ability to map elasticity of freshly excised malignant and benign human breast tissues.
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Affiliation(s)
- Kelsey M Kennedy
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic &Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Lixin Chin
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic &Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Robert A McLaughlin
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic &Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
| | - Bruce Latham
- PathWest, Fiona Stanley Hospital, Robin Warren Drive, Murdoch, WA 6150, Australia
| | - Christobel M Saunders
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.,Breast Clinic, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
| | - David D Sampson
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic &Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia.,Centre for Microscopy, Characterisation &Analysis, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Brendan F Kennedy
- Optical+Biomedical Engineering Laboratory, School of Electrical, Electronic &Computer Engineering, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia
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Ahmed M, Rubio IT, Klaase JM, Douek M. Surgical treatment of nonpalpable primary invasive and in situ breast cancer. Nat Rev Clin Oncol 2015; 12:645-63. [PMID: 26416152 DOI: 10.1038/nrclinonc.2015.161] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Breast cancer is the most-common cancer among women worldwide, and over one-third of all cases diagnosed annually are nonpalpable at diagnosis. The increasingly widespread implementation of breast-screening programmes, combined with the use of advanced imaging modalities, such as magnetic resonance imaging (MRI), will further increase the numbers of patients diagnosed with this disease. The current standard management for nonpalpable breast cancer is localized surgical excision combined with axillary staging, using sentinel-lymph-node biopsy in the clinically and radiologically normal axilla. Wire-guided localization (WGL) during mammography is a method that was developed over 40 years ago to enable lesion localization preoperatively; this technique became the standard of care in the absence of a better alternative. Over the past 20 years, however, other technologies have been developed as alternatives to WGL in order to overcome the technical and outcome-related limitations of this technique. This Review discusses the techniques available for the surgical management of nonpalpable breast cancer; we describe their advantages and disadvantages, and highlight future directions for the development of new technologies.
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Affiliation(s)
- Muneer Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Isabel T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Joost M Klaase
- Department of Surgery, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, Netherlands
| | - Michael Douek
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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Eggemann H, Costa SD, Ignatov A. Ultrasound-Guided Versus Wire-Guided Breast-Conserving Surgery for Nonpalpable Breast Cancer. Clin Breast Cancer 2015; 16:e1-6. [PMID: 26439275 DOI: 10.1016/j.clbc.2015.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/18/2015] [Accepted: 09/11/2015] [Indexed: 01/28/2023]
Abstract
PURPOSE To determine the efficacy of ultrasound (US)-guided excision of nonpalpable breast cancer and compare it to standard wire-guided breast-conserving surgery (BCS). METHODS One hundred fifty-eight women with nonpalpable breast cancer who underwent BCS were retrospectively studied. Positive surgical margins and reexcision rates were investigated. RESULTS Of the total cohort, 68 patients were treated with wire-guided and 90 with US-guided tumor excision. The tumor and patient characteristics were similar in the 2 groups; 13.2% and 12.2% of patients in the wire-guided and US-guided groups, respectively, had positive margins. Patient age, menopausal status, tumor size, histologic type, and histologic grade were associated with increased risk of positive margins. The shave margins were reexcised at the time of original operation more often by wire-guided localization (26.5%) than in the US-guided group (10.0%) (P = .010). The surgeon was able to identify correctly the problematic margin in 100% via intraoperative US and in only 27.8% when the wire-guided surgery was used (P < .001). The reexcision rate by a second operation was similar in 2 groups (P = .798). Eight (11.8%) of 68 patients in the wire-guided group and 9 (10.0%) of 90 patients in the US-guided underwent a second operation. CONCLUSION US-guided BCS is as effective and safe as standard wire-guided excision of nonpalpable breast tumors.
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Affiliation(s)
- Holm Eggemann
- Department of Obstetrics and Gynecology, Otto-von-Guericke University, Magdeburg, Germany
| | - Serban Dan Costa
- Department of Obstetrics and Gynecology, Otto-von-Guericke University, Magdeburg, Germany
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, Otto-von-Guericke University, Magdeburg, Germany.
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Jones V, Linebarger J, Perez S, Gabram S, Okoli J, Bumpers H, Burns B, Mosunjac M, Rizzo M. Excising Additional Margins at Initial Breast-Conserving Surgery (BCS) Reduces the Need for Re-excision in a Predominantly African American Population: A Report of a Randomized Prospective Study in a Public Hospital. Ann Surg Oncol 2015; 23:456-64. [DOI: 10.1245/s10434-015-4789-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 11/18/2022]
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Ivanovic NS, Zdravkovic DD, Skuric Z, Kostic J, Colakovic N, Stojiljkovic M, Opric S, Stefanovic Radovic M, Soldatovic I, Sredic B, Granic M. Optimization of breast cancer excision by intraoperative ultrasound and marking needle - technique description and feasibility. World J Surg Oncol 2015; 13:153. [PMID: 25896818 PMCID: PMC4404261 DOI: 10.1186/s12957-015-0568-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 04/04/2015] [Indexed: 12/30/2022] Open
Abstract
Background We present a surgical technique and the preliminary results of breast cancer excision after insertion of a specially constructed marking needle into the tumor, controlled by intraoperative ultrasound. Resection margins were projected in six directions by ultrasound measurements, determined in relation to the needle, and resection was done in accordance with those measurements. The main objective was to obtain resection margins similar (equal) to those projected by intraoperative ultrasound (10 mm). Methods Detailed description of the technique is given. Thirty-two female patients undergoing breast-conserving surgery, up to 30 mm in diameter, for palpable and non-palpable invasive breast cancer, were operated on using this technique. Its feasibility was tested by analyzing the success (rate) of needle placement in the tumor, the measurements executed, and the performance of the excision. Results All stages of the technique were successfully performed to completion on all 32 patients. The procedure of needle placement and ultrasound measurement of distances took 11 min on average (between 6 and 20 min). The average distance of the tumor margin from the resection margin was 12.9 mm (2 to 30 mm, 95% confidence interval [11.9, 14.06]). There was one patient with a positive resection margin (3%). Conclusions The technique of excising palpable and non-palpable breast cancer by intraoperative ultrasound and an especially constructed marking needle is feasible and comfortable to perform. Preliminary results imply that resection volume can be rationalized, with the same or better oncological safety.
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Affiliation(s)
- Nebojsa S Ivanovic
- Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. .,Medical Faculty of Belgrade University, Dr Subotica 8, Belgrade, 11000, Serbia.
| | - Darko D Zdravkovic
- Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. .,Medical Faculty of Belgrade University, Dr Subotica 8, Belgrade, 11000, Serbia.
| | - Zlatko Skuric
- Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia.
| | - Jelena Kostic
- Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia.
| | - Natasa Colakovic
- Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia.
| | - Miodrag Stojiljkovic
- Department of Pathology, UMC Bezanijska kosa, Autoput bb, Belgrade, 11000, Serbia.
| | - Svetlana Opric
- Department of Pathology, UMC Bezanijska kosa, Autoput bb, Belgrade, 11000, Serbia.
| | | | - Ivan Soldatovic
- Department of Statistics, Medical faculty of Belgrade University, Dr Subotica 8, Belgrade, 11000, Serbia.
| | - Biljana Sredic
- Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia.
| | - Miroslav Granic
- Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. .,Medical Faculty of Belgrade University, Dr Subotica 8, Belgrade, 11000, Serbia.
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Optimization of breast cancer excision by intraoperative ultrasound and marking needle - technique description and feasibility. World J Surg Oncol 2015. [PMID: 25896818 DOI: 10.1186/s12957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We present a surgical technique and the preliminary results of breast cancer excision after insertion of a specially constructed marking needle into the tumor, controlled by intraoperative ultrasound. Resection margins were projected in six directions by ultrasound measurements, determined in relation to the needle, and resection was done in accordance with those measurements. The main objective was to obtain resection margins similar (equal) to those projected by intraoperative ultrasound (10 mm). METHODS Detailed description of the technique is given. Thirty-two female patients undergoing breast-conserving surgery, up to 30 mm in diameter, for palpable and non-palpable invasive breast cancer, were operated on using this technique. Its feasibility was tested by analyzing the success (rate) of needle placement in the tumor, the measurements executed, and the performance of the excision. RESULTS All stages of the technique were successfully performed to completion on all 32 patients. The procedure of needle placement and ultrasound measurement of distances took 11 min on average (between 6 and 20 min). The average distance of the tumor margin from the resection margin was 12.9 mm (2 to 30 mm, 95% confidence interval [11.9, 14.06]). There was one patient with a positive resection margin (3%). CONCLUSIONS The technique of excising palpable and non-palpable breast cancer by intraoperative ultrasound and an especially constructed marking needle is feasible and comfortable to perform. Preliminary results imply that resection volume can be rationalized, with the same or better oncological safety.
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Harness JK, Giuliano AE, Pockaj BA, Downs-Kelly E. Margins: A Status Report from the Annual Meeting of the American Society of Breast Surgeons. Ann Surg Oncol 2014; 21:3192-7. [DOI: 10.1245/s10434-014-3957-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Indexed: 01/04/2023]
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35
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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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Pan H, Wu N, Ding H, Ding Q, Dai J, Ling L, Chen L, Zha X, Liu X, Zhou W, Wang S. Intraoperative ultrasound guidance is associated with clear lumpectomy margins for breast cancer: a systematic review and meta-analysis. PLoS One 2013; 8:e74028. [PMID: 24073200 PMCID: PMC3779206 DOI: 10.1371/journal.pone.0074028] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/25/2013] [Indexed: 01/27/2023] Open
Abstract
Purpose Margin status is one of the most important predictors of local recurrence after breast conserving surgery (BCS). Intraoperative ultrasound guidance (IOUS) has the potential to improve surgical accuracy for breast cancer. The purpose of the present meta-analysis was to determine the efficacy of IOUS in breast cancer surgery and to compare the margin status to that of the more traditional Guide wire localization (GWL) or palpation-guidance. Methods We searched the database of PubMed for prospective and retrospective studies about the impact of IOUS on margin status of breast cancer, and a meta-analysis was conducted. Results Of the 13 studies included, 8 were eligible for the impact of IOUS on margin status of non-palpable breast cancers, 4 were eligible for palpable breast cancers, and 1 was for both non-palpable and palpable breast cancers. The rate of negative margins of breast cancers in IOUS group was significantly higher than that in control group without IOUS (risk ratio (RR) = 1.37, 95% confidence interval (CI) = 1.18–1.59 from 7 prospective studies, odds ratio (OR) = 2.75, 95% CI = 1.66–4.55 from 4 retrospective studies). For non-palpable breast cancers, IOUS-guidance enabled a significantly higher rate of negative margins than that of GWL-guidance (RR = 1.26, 95% CI = 1.09–1.46 from 6 prospective studies; OR = 1.45, 95% CI = 0.86–2.43 from 2 retrospective studies). For palpable breast cancers, relative to control group without IOUS, the RR for IOUS associated negative margins was 2.36 (95% CI = 1.26–4.43) from 2 prospective studies, the OR was 2.71 (95% CI = 1.25–5.87) from 2 retrospective studies. Conclusion This study strongly suggests that IOUS is an accurate method for localization of non-palpable and palpable breast cancers. It is an efficient method of obtaining high proportion of negative margins and optimum resection volumes in patients undergoing BCS.
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Affiliation(s)
- Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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Ahmed M, Douek M. Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancers: systematic review and meta-analysis. Breast Cancer Res Treat 2013; 140:435-46. [PMID: 23877340 DOI: 10.1007/s10549-013-2639-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/09/2013] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The current standard of treatment for non-palpable breast cancers is wire-guided localization (WGL). WGL has its drawbacks and alternatives such as radio-guided surgery (RGL) and intra-operative ultrasound (IOUS) have been developed. The clinical effectiveness of all forms of RGL has been assessed against WGL in previous systematic reviews and meta-analyses. We performed the first systematic review and meta-analysis of IOUS in the management of non-palpable breast cancers. METHODS Studies were considered eligible for inclusion in this systematic review if they (1) assessed the role of surgeon-performed IOUS for the treatment of non-palpable breast cancers and ductal carcinoma in situ (DCIS) and (2) specified surgical margin excision status. Those studies, which were randomized controlled trials (RCTs) or cohort studies with comparison WGL groups were included in the meta-analysis. For those studies included in the meta-analysis, pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated using fixed-effects analyses and random-effects analyses in case of statistically significant heterogeneity (p < 0.05). RESULTS Eighteen studies reported data on IOUS in 1,328 patients with non-palpable breast cancer and DCIS. Nine cohort studies with control WGL groups and one RCT were included in the meta-analysis. Successful localization rates varied between 95 and 100 % in all studies and there was a statistically significant difference in the rates of involved surgical margins in favour of IOUS with pooled OR 0.52 (95 % CI 0.38-0.71). CONCLUSION Compared with WGL, IOUS reduces involved surgical margin rates. Adequately powered RCTs are required to validate these findings.
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Affiliation(s)
- M Ahmed
- Department of Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK.
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Camp MS, Valero MG, Opara N, Benabou K, Cutone L, Caragacianu D, Dominici L, Golshan M. Intraoperative digital specimen mammography: a significant improvement in operative efficiency. Am J Surg 2013; 206:526-9. [PMID: 23806823 DOI: 10.1016/j.amjsurg.2013.01.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/15/2013] [Accepted: 01/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The goal of this study was to determine the length of operative time and its effect on surgeon productivity with the use of intraoperative digital specimen mammography (IDSM) compared to standard specimen mammography (SSM). METHODS A retrospective chart review was performed on 344 consecutive patients from a single breast surgeon from 2003 to 2010. Operative time was compared between procedures using SSM vs IDSM. Surgeon productivity was evaluated by the number of wire-localized excisions performed prior to and after implementation of IDSM. RESULTS Two hundred thirty patients underwent SSM and 114 underwent IDSM. Average operative time in the SSM group was 78 minutes vs 68 minutes in the IDSM group (P < .0001). In the first 2 years after implementation of IDSM, the number of wire-localized excisions performed increased by 20%. CONCLUSIONS Operative times were significantly shorter with the use of IDSM vs SSM, and this was associated with an increase in surgeon productivity.
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Affiliation(s)
- Melissa S Camp
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Pinkney DM, Shah BA. Prospective Comparative Study to Evaluate the Sonographic Visibility of Five Commercially Available Breast Biopsy Markers. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479313486962] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The demand for highly sonographically visible breast biopsy markers is growing as an increasing number of physicians are using sonography for preoperative localization and single-step intraoperative ultrasound-guided excisional procedures. The objective of this study was to directly compare the sonographic visibility of five commercially available breast biopsy site markers. A single-site prospective comparative study was performed with 25 female participants, each assigned to receive one of five biopsy markers. Postdeployment, 6-week, and 12-week follow-up sonographic images were obtained and a survey was e-mailed to members of the Society of Breast Imaging asking them to grade marker visibility on a 1- to 5-point Likert-type scale. At the time of deployment, the SecurMark (Hologic, Bedford, Massachusetts) was rated with the highest sonographic visibility. At both 6 and 12 weeks after deployment, the HydroMARK (Biopsy Sciences, Clearwater, Florida) was found to be the most visible by sonography. The results can be used by physicians who require highly sonographically visible breast biopsy markers for ultrasound-guided interventional procedures. Further research is needed as biopsy marker manufacturers continue to refine their products.
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Affiliation(s)
| | - Biren A. Shah
- Wayne State University School of Medicine, Henry Ford Health System, Detroit, MI, USA
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Krekel NMA, Haloua MH, Lopes Cardozo AMF, de Wit RH, Bosch AM, de Widt-Levert LM, Muller S, van der Veen H, Bergers E, de Lange de Klerk ESM, Meijer S, van den Tol MP. Intraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial. Lancet Oncol 2012; 14:48-54. [PMID: 23218662 DOI: 10.1016/s1470-2045(12)70527-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast-conserving surgery for palpable breast cancer is associated with tumour-involved margins in up to 41% of cases and excessively large excision volumes. Ultrasound-guided surgery has the potential to resolve both of these problems, thereby improving surgical accuracy for palpable breast cancer. We aimed to compare ultrasound-guided surgery with the standard for palpable breast cancer-palpation-guided surgery-with respect to margin status and extent of healthy breast tissue resection. METHODS In this randomised controlled trial, patients with palpable T1-T2 invasive breast cancer were recruited from six medical centres in the Netherlands between October, 2010, and March, 2012. Eligible participants were randomly assigned to either ultrasound-guided surgery or palpation-guided surgery in a 1:1 ratio via a computer-generated random sequence and were stratified by study centre. Patients and investigators were aware of treatment assignments. Primary outcomes were surgical margin involvement, need for additional treatment, and excess healthy tissue resection (defined with a calculated resection ratio derived from excision volume and tumour diameter). Data were analysed by intention to treat. This trial is registered at http://www.TrialRegister.nl, number NTR2579. FINDINGS 134 patients were eligible for random allocation. Two (3%) of 65 patients allocated ultrasound-guided surgery had tumour-involved margins compared with 12 (17%) of 69 who were assigned palpation-guided surgery (difference 14%, 95% CI 4-25; p=0·0093). Seven (11%) patients who received ultrasound-guided surgery and 19 (28%) of those who received palpation-guided surgery required additional treatment (17%, 3-30; p=0·015). Ultrasound-guided surgery also resulted in smaller excision volumes (38 [SD 26] vs 57 [41] cm(3); difference 19 cm(3), 95% CI 7-31; p=0·002) and a reduced calculated resection ratio (1·0 [SD 0·5] vs 1·7 [1·2]; difference 0·7, 95% CI 0·4-1·0; p=0·0001) compared with palpation-guided surgery. INTERPRETATION Compared with palpation-guided surgery, ultrasound-guided surgery can significantly lower the proportion of tumour-involved resection margins, thus reducing the need for re-excision, mastectomy, and radiotherapy boost. By achieving optimum resection volumes, ultrasound-guided surgery reduces unnecessary resection of healthy breast tissue and could contribute to improved cosmetic results and quality of life. FUNDING Dutch Pink Ribbon Foundation, Osinga-Kluis Foundation, Toshiba Medical Systems.
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Affiliation(s)
- Nicole M A Krekel
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, Netherlands
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Ramos M, Díaz JC, Ramos T, Ruano R, Aparicio M, Sancho M, González-Orús JM. Ultrasound-guided excision combined with intraoperative assessment of gross macroscopic margins decreases the rate of reoperations for non-palpable invasive breast cancer. Breast 2012; 22:520-4. [PMID: 23110817 DOI: 10.1016/j.breast.2012.10.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 08/09/2012] [Accepted: 10/07/2012] [Indexed: 01/12/2023] Open
Abstract
AIMS The standard technique for intraoperative tumour localization of clinically occult tumours is wire-guided localization (WGL). This, however, this has several disadvantages. The aim of the present work is to report our single-centre experience with intraoperative ultrasound-guided (IOUS) excision, performed by surgeons, combined with intraoperative assessment of macroscopic pathologic and ultrasound margins in non-palpable invasive cancers indicated for conservative breast therapy. PATIENTS AND METHODS Two-hundred and twenty-five non-palpable invasive breast cancers were subjected to excision with IOUS. The lesion was located in the operating room with a high-frequency ultrasound probe (8-12 MHz), which was then used to guide surgical removal. The specimen margins were estimated by ultrasonography and macroscopic pathologic examination. The sensitivity of IOUS and effectiveness in the characterization of the specimen margins were evaluated, assessing the need for reoperation. RESULTS Pathologic tumour size was 12.0 ± 6.7 mm and 13 lesions (6.4 %) were <5 mm. The sensitivity of IOUS localization was 99.6% (224/225 cases). Only one cancer of less than 5 mm was not localized. The average weight of the specimens was 26.1 g. A second operation was required to remove margins in the 4% of cases (9/225). In 5 cases remains of in situ or invasive carcinoma were found. In two cases, conservative surgery was converted to mastectomy. CONCLUSIONS IOUS excision combined with the intraoperative assessment of the macroscopic margins of non-palpable breast cancers is a safe, useful, and efficient technique. We obtained an excellent characterization of tumour margins with moderate removal of breast tissue and consequently a lower number of reoperations were required and good cosmetic results were obtained. We believe that use of this technique in conservative breast cancer surgery should be recommended.
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Affiliation(s)
- Manuel Ramos
- Department of Surgery, Breast Surgery Unit, Salamanca University Hospital, Paseo S.Vicente 82, 37002 Salamanca, Spain.
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Barentsz MW, van Dalen T, Gobardhan PD, Bongers V, Perre CI, Pijnappel RM, van den Bosch MAAJ, Verkooijen HM. Intraoperative ultrasound guidance for excision of non-palpable invasive breast cancer: a hospital-based series and an overview of the literature. Breast Cancer Res Treat 2012; 135:209-19. [PMID: 22872521 DOI: 10.1007/s10549-012-2165-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/09/2012] [Indexed: 12/22/2022]
Abstract
Intraoperative ultrasound (IOUS) can be used in the operation theatre for localization of non-palpable breast cancers. In this prospective cohort study, we compared the yield of IOUS to guidewire localization (GWL). A total of 258 consecutive patients with non-palpable invasive breast cancer underwent breast conserving surgery between 1999 and 2010. GWL was performed in 138 (54 %) and IOUS in 120 (46 %) patients. Tumor dimensions, resection volume, margin status and re-excision rates were compared by means of multivariate regression analysis. The groups were similar in terms of age, histological subtype and presence of DCIS. Lesions in the IOUS group were larger (1.24 vs. 0.98 cm, P < 0.001), while microcalcifications were more common in the GWL group (19 vs. 3 %, P < 0.001). Even after stratification for tumor diameter, presence of DCIS and findings on mammography, resection volumes were similar in both groups. Tumor-free resection margins were obtained in >93 % of patients (93.5 % with GWL vs. 93.3 % with IOUS, P = 0.958) and re-excision was performed in 11 % of patients undergoing GWL and 12.5 % of patients undergoing IOUS (P = 0.684). For localization of non-palpable breast cancer, IOUS is a reliable alternative to GWL, as it achieves similar results in terms of complete tumor removal, re-excision rate and excised volume.
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Affiliation(s)
- M W Barentsz
- Department of Radiology, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Affiliation(s)
- Basak E Dogan
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA.
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Fisher CS, Mushawah FA, Cyr AE, Gao F, Margenthaler JA. Ultrasound-guided lumpectomy for palpable breast cancers. Ann Surg Oncol 2011; 18:3198-203. [PMID: 21861232 DOI: 10.1245/s10434-011-1958-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND We sought to determine the re-excision rate following lumpectomy for palpable breast cancers using intraoperative ultrasound (US). A secondary aim was to investigate the impact on surgical decision-making. METHODS We identified 73 women who underwent US-guided lumpectomy for palpable breast cancer between 2006 and 2010. A cohort of 124 women who underwent palpation-guided lumpectomy was used for a comparison group. Data included patient demographics, tumor characteristics, intraoperative findings, and pathologic outcomes. Descriptive statistics were used for data summary and compared by chi-square or t test, as appropriate. RESULTS A total of 73 women underwent US-guided lumpectomy, and 124 women underwent palpation-guided lumpectomy (median age 55 years). Patients undergoing palpation-guided lumpectomy had smaller tumors that were more likely to be HER2/neu amplified compared with patients undergoing US-guided lumpectomy (P < 0.05 for each). There were no differences between the 2 groups with respect to patient age, tumor grade, and estrogen/progesterone receptor status (P > 0.05 for each). Re-excision rates were similar in both groups [17 (23%) in the US group versus 31 (25%) in the palpation group; P > 0.05]. In the US group, 45 patients (62%) had additional shave margins taken based on US interrogation of the specimen, and 12 patients (16%) were spared a 2nd procedure based on the use of intraoperative US. CONCLUSIONS Although palpable breast cancers can be excised based on direct palpation or needle localization, we believe that US guidance provides an excellent tool to aid the breast surgeon. Only 10% of patients had a positive margin on final pathology as a result, and the overall re-excision rate was acceptable.
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Affiliation(s)
- Carla S Fisher
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Krekel NMA, Zonderhuis BM, Stockmann HBAC, Schreurs WH, van der Veen H, de Lange de Klerk ESM, Meijer S, van den Tol MP. A comparison of three methods for nonpalpable breast cancer excision. Eur J Surg Oncol 2010; 37:109-15. [PMID: 21194880 DOI: 10.1016/j.ejso.2010.12.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 11/17/2010] [Accepted: 12/06/2010] [Indexed: 12/14/2022] Open
Abstract
AIMS To evaluate the efficacy of three methods of breast-conserving surgery (BCS) for nonpalpable invasive breast cancer in obtaining adequate resection margins and volumes of resection. MATERIALS AND METHODS A total of 201 consecutive patients undergoing BCS for nonpalpable invasive breast cancer between January 2006 and 2009 in four affiliated institutions was retrospectively analysed. Patients with pre-operatively diagnosed primary or associated ductal carcinoma in situ (DCIS), multifocal disease, or a history of breast surgery or neo-adjuvant treatment were excluded from the study. The resections were guided by wire localisation (WL), ultrasound (US), or radio-guided occult lesion localisation (ROLL). The pathology reports were reviewed to determine oncological margin status, as well as tumour and surgical specimen sizes. The optimal resection volume (ORV), defined as the spherical tumour volume with an added 1.0-cm margin, and the total resection volume (TRV), defined as the corresponding ellipsoid, were calculated. By dividing the TRV by the ORV, a calculated resection ratio (CRR) was determined to indicate the excess tissue resection. RESULTS Of all 201 excisions, 117 (58%) were guided by WL, 52 (26%) by US, and 32 (16%) by ROLL. The rate of focally positive and positive margins for invasive carcinoma was significantly lower in the US group (N = 2 (3.7%)) compared to the WL (N = 25 (21.3%)) and ROLL (N = 8 (25%)) groups (p = 0.023). The median CRRs were 3.2 (US), 2.8 (WL) and 3.8 (ROLL) (WL versus ROLL, p < 0.05), representing a median excess tissue resection of 3.1 times the optimal resection volume. CONCLUSION US-guided BCS for nonpalpable invasive breast cancer was more accurate than WL- and ROLL-guided surgery because it optimised the surgeon's ability to obtain adequate margins. The excision volumes were large in all excision groups, especially in the ROLL group.
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Affiliation(s)
- N M A Krekel
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Mundinger A, Wilson A, Weismann C, Madjar H, Heindel W, Durante E. E5. Breast ultrasound – update. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70009-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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