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Levy Y, Rempel D, Nguyen M, Yassine A, Sanati-Burns M, Salgia P, Lim B, Butler SL, Berkeley A, Bayram E. The Fusion of Wide Field Optical Coherence Tomography and AI: Advancing Breast Cancer Surgical Margin Visualization. Life (Basel) 2023; 13:2340. [PMID: 38137941 PMCID: PMC10744864 DOI: 10.3390/life13122340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/23/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
This study explores the integration of Wide Field Optical Coherence Tomography (WF-OCT) with an AI-driven clinical decision support system, with the goal of enhancing productivity and decision making in breast cancer surgery margin assessment. A computationally efficient convolutional neural network (CNN)-based binary classifier is developed using 585 WF-OCT margin scans from 151 subjects. The CNN model swiftly identifies suspicious areas within margins with an on-device inference time of approximately 10 ms for a 420 × 2400 image. In independent testing on 155 pathology-confirmed margins, including 31 positive margins from 29 patients, the classifier achieved an AUROC of 0.976, a sensitivity of 0.93, and a specificity of 0.98. At the margin level, the deep learning model accurately identified 96.8% of pathology-positive margins. These results highlight the clinical viability of AI-enhanced margin visualization using WF-OCT in breast cancer surgery and its potential to decrease reoperation rates due to residual tumors.
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Affiliation(s)
- Yanir Levy
- Perimeter Medical Imaging AI Inc., 555 Richmond St W #511, Toronto, ON M5V 3B1, Canada; (D.R.); (M.S.-B.); (A.B.)
| | - David Rempel
- Perimeter Medical Imaging AI Inc., 555 Richmond St W #511, Toronto, ON M5V 3B1, Canada; (D.R.); (M.S.-B.); (A.B.)
| | - Mark Nguyen
- Perimeter Medical Imaging AI Inc., 8585 N Stemmons Fwy Suite 106N, Dallas, TX 75247, USA; (M.N.); (P.S.); (S.L.B.)
| | - Ali Yassine
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 1A1, Canada;
| | - Maggie Sanati-Burns
- Perimeter Medical Imaging AI Inc., 555 Richmond St W #511, Toronto, ON M5V 3B1, Canada; (D.R.); (M.S.-B.); (A.B.)
| | - Payal Salgia
- Perimeter Medical Imaging AI Inc., 8585 N Stemmons Fwy Suite 106N, Dallas, TX 75247, USA; (M.N.); (P.S.); (S.L.B.)
| | - Bryant Lim
- The Institute of Biomedical Engineering, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 1A1, Canada;
| | - Sarah L. Butler
- Perimeter Medical Imaging AI Inc., 8585 N Stemmons Fwy Suite 106N, Dallas, TX 75247, USA; (M.N.); (P.S.); (S.L.B.)
| | - Andrew Berkeley
- Perimeter Medical Imaging AI Inc., 555 Richmond St W #511, Toronto, ON M5V 3B1, Canada; (D.R.); (M.S.-B.); (A.B.)
| | - Ersin Bayram
- Perimeter Medical Imaging AI Inc., 8585 N Stemmons Fwy Suite 106N, Dallas, TX 75247, USA; (M.N.); (P.S.); (S.L.B.)
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Zhao R, Zhang J, Gao J. Blood flow on ultrasound imaging is a predictor of lump margin status in breast-conserving patients: a retrospective matching study. Eur J Med Res 2023; 28:357. [PMID: 37730626 PMCID: PMC10510181 DOI: 10.1186/s40001-023-01356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE This study investigated the relationship between breast ultrasound features and lump margin status in breast-conserving patients. METHODS A single-institution database and medical records system were searched to identify patients who had undergone breast-conserving surgery between 2015 and 2022. Patients were divided into case and control groups based on their postoperative margin status, and different matching methods [case-control matching (CCM) and propensity score matching (PSM)] were used to match the cases and controls at a ratio of 1:1. RESULTS Before matching, patients with positive margins were more likely to have a tumor with increased blood flow (OR = 2.90, 95% CI 1.83-4.61, p < 0.001) and microcalcifications (OR = 2.22, 95% CI 1.44-3.42, p < 0.001). Among the 83 pairs of CCM subjects, patients with positive margins were prone to increased blood flow (p = 0.007) and crab sign (p = 0.040). In addition, there was a significant difference in blood flow (p = 0.030) among PSM subjects. After adjusting for the unbalanced factors, the same results were obtained. CONCLUSIONS Ultrasound blood flow significantly predicts the status of breast-conserving margins, but further studies are required to verify our findings.
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Affiliation(s)
- Rong Zhao
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Jianyong Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Jinnan Gao
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
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Diagnostic performance of tomosynthesis, digital mammography and a dedicated digital specimen radiography system versus pathological assessment of excised breast lesions. Radiol Oncol 2022; 56:461-470. [PMID: 36226804 PMCID: PMC9784367 DOI: 10.2478/raon-2022-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/06/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The aim of the study was to compare the performance of full-field digital mammography (FFDM), digital breast tomosynthesis and a dedicated digital specimen radiography system (SRS) in consecutive patients, and to compare the margin status of resected lesions versus pathological assessment. PATIENTS AND METHODS Resected tissue specimens from consecutive patients who underwent intraoperative breast specimen assessment following wide local excision or oncoplastic breast conservative surgery were examined by FFDM, tomosynthesis and SRS. Two independent observers retrospectively evaluated the visibility of lesions, size, margins, spiculations, calcifications and diagnostic certainty, and chose the best performing method in a blinded manner. RESULTS We evaluated 216 specimens from 204 patients. All target malignant lesions were removed with no tumouron-ink. One papilloma had positive microscopic margins and one patient underwent reoperation owing to extensive in situ components. There were no significant differences in measured lesion size among the three methods. However, tomosynthesis was the most accurate modality when compared with the final pathological report. Both observers reported that tomosynthesis had significantly better lesion visibility than SRS and FFDM, which translated into a significantly greater diagnostic certainty. Tomosynthesis was superior to the other two methods in identifying spiculations and calcifications. Both observers reported that tomosynthesis was the best performing method in 76.9% of cases. The interobserver reproducibilities of lesion visibility and diagnostic certainty were high for all three methods. CONCLUSIONS Tomosynthesis was superior to SRS and FFDM for detecting and evaluating the target lesions, spiculations and calcifications, and was therefore more reliable for assessing complete excision of breast lesions.
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De la Flor M, Delgado C, Martínez S, Arenas M, Gómez M, Reig R. Rate of effect of surgical margins after breast conserving surgery and estimation of direct costs. Cir Esp 2022; 100:702-708. [PMID: 35850474 DOI: 10.1016/j.cireng.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Assessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital. METHOD 146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System. RESULTS The rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129,696.89, € 82,654.34 in conservative surgeries (€ 3757.01 on average per patient) and € 47,042.55 in mastectomies (€ 6720.36 on average per patient). CONCLUSIONS Margin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact.
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Affiliation(s)
- Miriam De la Flor
- Unidad de Patología Mamaria, Servicio de Ginecología y Obstetricia, H.U. Tarragona Joan XXIII, URV, Tarragona, Spain.
| | - Cinthia Delgado
- Departamento de Medicina y Cirugía, Universitat Rovira i Virgili, Tarragona, Spain
| | - Salomé Martínez
- Unidad de Patología Mamaria, Servicio de Anatomía Patológica, H.U. Tarragona Joan XXIII, URV, Tarragona, Spain
| | - Meritxell Arenas
- Unidad de Patología Mamaria, Servicio de Oncología Radioterápica, H.U. Sant Joan Reus, URV, Tarragona, Spain
| | - María Gómez
- Unidad de Patología Mamaria, Servicio de Oncología Radioterápica, H.U. Sant Joan Reus, URV, Tarragona, Spain
| | - Rosaura Reig
- Dirección Médica, H.U. Tarragona Joan XXIII, Tarragona, Spain
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Zhao R, Xing J, Gao J. Development and Validation of a Prediction Model for Positive Margins in Breast-Conserving Surgery. Front Oncol 2022; 12:875665. [PMID: 35646633 PMCID: PMC9133412 DOI: 10.3389/fonc.2022.875665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background The chances of second surgery due to positive margins in patients receiving breast-conversing surgery (BCS) were about 20-40%. This study aims to develop and validate a nomogram to predict the status of breast-conserving margins. Methods The database identified patients with core needle biopsy-proven ductal carcinoma in situ (DCIS) or invasive breast carcinoma who underwent BCS in Shanxi Bethune Hospital between January 1, 2015 and December 31, 2021 (n = 573). The patients were divided into two models: (1) The first model consists of 398 patients who underwent BCS between 2015 and 2019; (2) The validation model consists of 175 patients who underwent BCS between 2020 and 2021. The development of the nomogram was based on the findings of multivariate logistic regression analysis. Discrimination was assessed by computing the C-index. The Hosmer-Lemeshow goodness-of-fit test was used to validate the calibration performance. Results The final multivariate regression model was developed as a nomogram, including blood flow signals (OR = 2.88, p = 0.001), grade (OR = 2.46, p = 0.002), microcalcifications (OR = 2.39, p = 0.003), tumor size in ultrasound (OR = 2.12, p = 0.011) and cerbB-2 status (OR = 1.99, p = 0.042). C-indices were calculated of 0.71 (95% CI: 0.64-0.78) and 0.68 (95% CI: 0.59-0.78) for the modeling and the validation group, respectively. The calibration of the model was considered adequate in the validation group (p > 0.05). Conclusion We developed a nomogram that enables the estimation of the preoperative risk of positive BCS margins. Our nomogram provides a valuable tool for identifying high-risk patients who might have to undergo a wider excision.
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Affiliation(s)
- Rong Zhao
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jun Xing
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jinnan Gao
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
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Does conventional specimen radiography after neoadjuvant chemotherapy of breast cancer help to reduce the rate of second surgeries? Breast Cancer Res Treat 2021; 191:589-598. [PMID: 34878635 PMCID: PMC8831236 DOI: 10.1007/s10549-021-06466-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/04/2021] [Indexed: 12/12/2022]
Abstract
Purpose This is the first study to systematically evaluate the diagnostic accuracy of intraoperative specimen radiography on margin level and its potential to reduce second surgeries in patients treated with neoadjuvant chemotherapy. Methods This retrospective study included 174 cases receiving breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. Conventional specimen radiography (CSR) was performed to assess potential margin infiltration and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. Results 1044 margins were assessed. Of 47 (4.5%) histopathological positive margins, CSR identified 9 correctly (true positive). 38 infiltrated margins were missed (false negative). This resulted in a sensitivity of 19.2%, a specificity of 89.2%, a positive predictive value (PPV) of 7.7%, and a negative predictive value (NPV) of 95.9%. The rate of secondary procedures was reduced from 23 to 16 with a number needed to treat (NNT) of CSR-guided intraoperative re-excisions of 25. In the subgroup of patients with cCR, the prevalence of positive margins was 10/510 (2.0%), PPV was 1.9%, and the NNT was 85. Conclusion Positive margins after NACT are rare and CSR has only a low sensitivity to detect them. Thus, the rate of secondary surgeries cannot be significantly reduced by recommending targeted re-excisions, especially in cases with cCR. In summary, CSR after NACT is inadequate for intraoperative margin assessment but remains useful to document removal of the biopsy site clip.
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De la Flor M, Delgado C, Martínez S, Arenas M, Gómez M, Reig R. Rate of effect of surgical margins after breast conserving surgery and estimation of direct costs. Cir Esp 2021; 100:S0009-739X(21)00244-X. [PMID: 34399974 DOI: 10.1016/j.ciresp.2021.07.003] [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: 06/09/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Assessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital. METHOD 146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System. RESULTS The rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129.696,89, € 82.654,34 in conservative surgeries (€ 3.757,01 on average per patient) and € 47.042,55 in mastectomies (€ 6.720,36 on average per patient). CONCLUSIONS Margin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact.
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Affiliation(s)
- Miriam De la Flor
- Unidad de Patología Mamaria, Servicio de Ginecología y Obstetricia, H.U. Tarragona Joan XXIII, URV, Tarragona, España.
| | - Cinthia Delgado
- Departamento de Medicina y Cirugía, Universitat Rovira i Virgili, Tarragona, España
| | - Salomé Martínez
- Unidad de Patología Mamaria, Servicio de Anatomía Patológica, H.U. Tarragona Joan XXIII, URV, Tarragona, España
| | - Meritxell Arenas
- Unidad de Patología Mamaria, Servicio de Oncología Radioterápica, H.U. Sant Joan Reus, URV, Tarragona, España
| | - María Gómez
- Unidad de Patología Mamaria, Servicio de Oncología Radioterápica, H.U. Sant Joan Reus, URV, Tarragona, España
| | - Rosaura Reig
- Dirección Médica, H.U. Tarragona Joan XXIII, Tarragona, España
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Garzotto F, Comoretto RI, Michieletto S, Franzoso G, Lo Mele M, Gregori D, Bonavina MG, Bozza F, Caumo F, Saibene T. Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: A systematic review and meta-analysis. Breast 2021; 58:93-105. [PMID: 33991806 PMCID: PMC8481910 DOI: 10.1016/j.breast.2021.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022] Open
Abstract
Pre-operative localization of non-palpable breast lesions with non-wired non-ionizing (NWNI) techniques may improve clinical outcomes as reoperation rate, cosmetic outcome and contribute to organizational aspects improvement in breast-conserving surgery (BCS). However only limited literature is available and clinical studies involving these forefront devices are often small and non-randomized. Furthermore, there is a lack of consensus on free margins and cosmetic outcomes definitions. The objective of the present meta-analysis was to determine the crude clinical outcomes reported for the NWNI techniques on BCS. A literature search was performed of PubMed, Embase and Scopus databases up to February 2021 in order to select all prospective or retrospective clinical trials on pre-operative breast lesion localization done with NWNI devices. All studies were assessed following the PRISMA recommendations. Continuous outcomes were described in averages corrected for sample size, while binomial outcomes were described using the weighted average proportion. Twenty-seven studies with a total of 2103 procedures were identified. The technique is consolidated, showing for both reflectors' positioning and localization nearly the 100% rate of success. The re-excision and clear margins rates were 14% (95% CI, 11-17%) and 87% (80-92%), respectively. Overall, positive margins rates were 12% (8-17%). In studies that compared NWNI and wire localization techniques, positive margin rate is lower for the first techniques (12%, 6-22% vs 17%, 12-23%) and re-excision rate is slightly higher using the latter (13%, 9-19% vs 16%, 13-18%). Pre-operative NWNI techniques are effective in the localization of non-palpable breast lesions and are promising in obtaining clear (or negative) margins minimizing the need for re-excision and improving the cosmetic outcomes. Randomized trials are needed to confirm these findings.
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Affiliation(s)
- Francesco Garzotto
- Breast Radiology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
| | - Rosanna Irene Comoretto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Silvia Michieletto
- Breast Surgery Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | | | - Marcello Lo Mele
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, 35121, Italy
| | - Dario Gregori
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | | | - Fernando Bozza
- Breast Surgery Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Francesca Caumo
- Breast Radiology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Tania Saibene
- Breast Surgery Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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Koopmansch C, Noël JC, Maris C, Simon P, Sy M, Catteau X. Intraoperative Evaluation of Resection Margins in Breast-Conserving Surgery for In Situ and Invasive Breast Carcinoma. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:1178223421993459. [PMID: 33854326 PMCID: PMC8013925 DOI: 10.1177/1178223421993459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
Background: The challenge of breast-conserving surgery (BCS) is to remove the entire tumour with free margins and avoid secondary excision that may adversely affect the cosmetic outcome. Consequently, intraoperative evaluation of surgical margins is critical. The aims of this study were multiple. First, to analyse our methodology of intraoperative examination of the resection margins and to evaluate radiological and pathological methods in the assessment of the surgical margins. Second, to evaluate the factors associated with positive margins in our patient population. M&m: The data on the resection margin status of 290 patients who underwent BCS for invasive carcinoma or ductal carcinoma in situ (DCIS) between 2009 and 2016 were reviewed. Results: In the cohort of BCS with invasive carcinoma, the negative predictive value was 97.4% for intraoperative assessment by radiography and 81.8% for intraoperative assessment by pathology. The re-operation rate among cases without intraoperative assessment was 23.6% compared to 7.3% among cases with intraoperative assessment (P = .003). Margin status was significantly associated with tumour size, histological subtype (invasive lobular carcinoma), and multifocality. In the population of BCS with DCIS, margin status was significantly associated with preoperative localisation and intraoperative margin assessment (P = .03). Conclusion: There is no statistical difference between pathological and radiological intraoperative assessment. Tumour size, lobular subtype, and multifocality were found to be significantly associated with positive margins in cases with invasive carcinoma, whereas absence of intraoperative margin assessment was significantly associated with positive margins in cases with DCIS. Therefore, intraoperative margin assessment improves the likelihood of complete excision of the lesion.
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Affiliation(s)
- Caroline Koopmansch
- Department of Pathology, Pathology and Genetic Institute, Gosselies, Belgium
| | - Jean-Christophe Noël
- Department of Pathology, Erasme University Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Calliope Maris
- Department of Pathology, Erasme University Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Philippe Simon
- Department of Gynaecology, Erasme University Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Marième Sy
- Department of Radiology, Erasme University Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Xavier Catteau
- Department of Pathology, CUREPATH laboratory (CHIREC, CHU Tivoli), Jumet, Belgium
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Tamanuki T, Namura M, Aoyagi T, Shimizu S, Suwa T, Matsuzaki H. Effect of Intraoperative Imprint Cytology Followed by Frozen Section on Margin Assessment in Breast-Conserving Surgery. Ann Surg Oncol 2020; 28:1338-1346. [PMID: 32815080 DOI: 10.1245/s10434-020-08955-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/11/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Intraoperative margin assessment can reduce positive margins in patients undergoing breast-conserving surgery. However, reports on intraoperative margin assessment have described only the use of either imprint cytology or frozen section. This study was designed to elucidate the effect of intraoperative margin assessment using imprint cytology followed by frozen section. METHODS Overall, 522 patients were enrolled. First, the entire surgical margin was subjected to imprint cytology. Frozen section was performed only in cases with "positive" or "suspicious" imprint cytology results. An additional intraoperative excision was performed in patients with frozen section-positive lesion sites. All margins were evaluated using postoperative permanent sections after excision. RESULTS Among 522 patients, 136 (26.1%) were imprint cytology-positive, and 386 (73.9%) were imprint cytology-negative. Among the 386 imprint cytology-negative patients not subjected to frozen section, 11 (2.1%) were permanent sections-positive (imprint cytology-false-negative). In 47 of the 136 imprint cytology-positive patients, additional intraoperative excision was unnecessary due to the frozen section-negative diagnosis. Moreover, these patients could avoid reoperation, because they were permanent section-negative. The false-positive rate of imprint cytology alone was 13.4%, but adding frozen section to imprint cytology decreased the overall false-positive rate to 2.5%. After undergoing excision, four patients still had positive margins. The overall positive margin rate in the final pathology based on permanent sections was 2.9% (15/522). CONCLUSIONS Imprint cytology followed by frozen section led to a markedly decreased positive margin rate. This is considered the best method for intraoperative margin assessment, as it can overcome the limitations of cytology and histology performed individually.
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Affiliation(s)
- Tamaki Tamanuki
- Department of Breast Surgical Oncology, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
| | - Maki Namura
- Department of Breast Surgical Oncology, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Tomoyoshi Aoyagi
- Department of Breast Surgical Oncology, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
| | - Sinichirou Shimizu
- Department of Pathology, Funabashi Municipal Medical Center, Funabashi, Chiba, Japan
| | - Tomoko Suwa
- Department of Pathology, Funabashi Municipal Medical Center, Funabashi, Chiba, Japan
| | - Hiroshi Matsuzaki
- Department of Breast Surgical Oncology, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan
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Ghamrini YE, Salama TM, Hassan MI, Nasser HM. Mapping of multifocal breast cancer to achieve negative margins: A new step in the evolution of conservative breast surgery(A cohort study). Ann Med Surg (Lond) 2020; 56:28-33. [PMID: 32577228 PMCID: PMC7303525 DOI: 10.1016/j.amsu.2020.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022] Open
Abstract
Conservative breast surgery is the standard technique in breast cancer. Multifocal breast cancer is a risk factor for involved margins. Positive margins are considered one of the predictors for local recurrence. Preoperative wire mapping after breast marking by the surgeon increase the chance to have negative margins.
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Affiliation(s)
- Yasser El Ghamrini
- Associate Professor of General Surgery, Ain Shams University, Cairo, Egypt
- Corresponding author. 17 El Abdelhamid Lotfy Street, Nasr city, Cairo, Egypt.
| | - Tamer M.S. Salama
- Associate Professor of General Surgery, Ain Shams University, Cairo, Egypt
| | - Mohamed I. Hassan
- Associate Professor of General Surgery, Ain Shams University, Cairo, Egypt
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12
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Efficacy of intraoperative specimen radiography as margin assessment tool in breast conserving surgery. Breast Cancer Res Treat 2019; 179:425-433. [PMID: 31654190 DOI: 10.1007/s10549-019-05476-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To explore the ability of intraoperative specimen radiography (SR) to correctly identify positive margins in patients receiving breast conserving surgery (BCS). To assess whether the reoperation rate can be reduced by using this method. METHODS This retrospective study included 470 consecutive cases receiving BCS due to a primarily diagnosed breast cancer. SR was carried out in two planes, assessing the specimen regarding the presence of the lesion and its relation to all margins. If indicated, re-excision of selective orientations was advised. Under consideration of gross inspection and the SR-findings, it was up to the surgeon whether to perform re-resections. The recommendations for re-excision were, separately for each orientation, compared to the histopathological results, serving as gold standard. RESULTS Intraoperative SR was performed in 470 cases, thus 2820 margins were assessed. Of those, 2510 (89.0%) were negative and 310 (11.0%) positive. SR identified 2179 (77.3%) margins correctly as negative, whereas 331 (11.7%) clear margins were misjudged as positive. Of 310 infiltrated margins, SR identified 114 (4.0%) correctly, whereas 196 (7.0%) infiltrated margins were missed. This resulted in a sensitivity/specificity of 36.8%/86.8% and PPV/NPV of 25.6%/91.8%. Through targeted re-resections positive margins could be reduced by 31.0% [310 to 214 (7.6%)]. On case level, the rate of secondary procedures could be reduced by 37.0% [from 162 to 102 (21.7%)]. CONCLUSIONS SR is a helpful tool to identify infiltrated margins and to reduce the rate of secondary surgeries by recommending targeted re-excisions of according orientations in order to obtain a final negative margin status.
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Adoption and outcomes of radioguided seed localization for non-palpable invasive and in-situ breast cancer at three academic tertiary care centers. Am J Surg 2018; 216:1160-1165. [DOI: 10.1016/j.amjsurg.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 11/23/2022]
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Trippel M, Slotta-Huspenina J, Becker K, Rau T, Paepke S, Maurer-Marti F, Langer R. Macroscopic Evaluation of the Trimmed Frozen Block Is a Helpful Tool for Intraoperative Assessment of Resection Margins of Breast Cancer Specimens. Int J Surg Pathol 2018; 26:693-700. [PMID: 29953301 DOI: 10.1177/1066896918780346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The evaluation of the trimming surfaces (TS) of tissue blocks from frozen sections may serve as a supplementary examination tool for the intraoperative determination of resection margins of breast cancer specimens. This study aimed at the investigation of the feasibility and reliability of this technique, which has been described only very rarely in literature. METHODS Two observers assessed digital images from TS obtained from 57 resection margins. Findings were correlated with the diagnosis of the frozen section (FS) alone and the final diagnosis on formalin-fixed paraffin-embedded (FFPE) material. RESULTS The determination of the resection margin on TS was estimated as feasible for all cases. Interobserver congruence rate for TS was 96% (κ = 0.81), which was lower compared with FFPE (100%, κ = 1.0) but superior to FS (89%, κ = 0.67). Intraobserver congruence of the 2 reviewers was 96.5% and 93.0% between TS and FFPE, and 91.1% and 92.5% between FS and FFPE, respectively. The combination of both intraoperative consultation techniques showed similar congruence but a slight improvement for the sensitivity (0.75 to 0.875) for the diagnosis of tumor at the resection margin in FFPE for Reviewer 1 but was unchanged for Reviewer 2. CONCLUSION The additional evaluation of TS can be a helpful additional tool for intraoperative margin assessment of breast cancer specimens, in particular, when processing artifacts of FS are encountered.
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Affiliation(s)
| | | | - Karen Becker
- 2 Technische Universität München, München, Germany
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Larson KE, Jadeja P, Marko A, Jadeja V, Pratt D. Radiographically guided shave margins may reduce lumpectomy re-excision rates. Breast J 2018; 24:820-822. [DOI: 10.1111/tbj.13050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Kelsey E. Larson
- Department of Breast Surgery; Cleveland Clinic; Cleveland OH USA
| | | | - Alison Marko
- Northeast Ohio Medical University; Rootstown OH USA
| | | | - Debra Pratt
- Cleveland Clinic; Fairview Hospital; Cleveland OH USA
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Eng JL, Baliski CR, McGahan C, Cai E. Uptake and impact of synoptic reporting in a community care setting. Am J Surg 2018; 215:857-861. [PMID: 29496204 DOI: 10.1016/j.amjsurg.2018.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/25/2017] [Accepted: 01/02/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Breast cancer surgeries have traditionally been documented in narrative reports. Narrative reports have been shown to be incomplete. Synoptic reports utilize standardized templates to record data and have emerged as an alternative to narrative reports. This study evaluates the uptake and impact of synoptic reporting for breast cancer surgery in a community care setting. METHODS A retrospective review of operative reports documenting breast cancer surgeries over a consecutive 3-year period. RESULTS 772 narrative reports and 158 synoptic reports were reviewed. Synoptic reports were associated with a higher degree of overall completeness (60% vs 45%) when compared to narrative reports. 6 out of 7 surgeons that produced at least 5 synoptic and 5 narrative reports had increases in completeness with use of synoptic reporting. CONCLUSIONS Use of synoptic reporting improves breast cancer operative report completeness and decreases superfluous content when compared to narrative reports. While synoptic report uptake during the study period was suboptimal there exists several means by which it can be improved, including investment in information technology infrastructure and emphasis on stakeholder engagement.
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Affiliation(s)
- Jordan Lang Eng
- Department of Surgery, Dalhousie University, 849-1276 South Park Street Street, Halifax, NS, B3H 2Y9, Canada.
| | - Christopher Ronald Baliski
- Surgical Oncology, BC Cancer Agency (SAH-CSI), 399 Royal Avenue, Kelowna, BC, V1Y 5L3, Canada; Surgical Oncology Network, 399 Royal Avenue, Kelowna, BC, V1Y 5L3, Canada; Department of Surgery, University of British Columbia, 399 Royal Avenue, Kelowna, BC, V1Y 5L3, Canada
| | - Colleen McGahan
- BC Cancer Agency, 801 - 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
| | - Eric Cai
- British Columbia Cancer Agency Research Centre, 703-686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
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Hernanz F, González-Noriega M, Sánchez S, Paz L, Muñoz P, Hermana S. Oncoplastic breast conserving surgery with tailored needle-guided excision. Gland Surg 2018; 6:698-705. [PMID: 29302488 DOI: 10.21037/gs.2017.06.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Breast conserving surgery (BCS) administered with oncoplastic approach (OBCS), when it is required, is currently the gold standard for the treatment of early breast cancer. Wire-guided localization (WL) is the most popular technique used to help surgeon in breast cancer excision. Currently, a universal and undeniable goal is to minimize the rate of positive margins and re-excision operation after BCS improving cosmetic outcome and decreasing health care costs. This study is aimed to report our experience combining OBCS and tailored WL as surgical approach for early breast cancers. Methods We performed a retrospective study on 148 breast cancer patients who were treated with OBCS and tailored WL, which consists in individualization of the number and location of wires depending on patient particularities, in our Breast Unit from March 2013 to December 2015. A multivariate analysis was used to determine the association between clinic-pathologic variables, which can be known preoperatively, and margin status. Results The rate of affected margins was 13.5% and 10.8% patients underwent re-interventions for oncologic reasons. Multifocality was strongly associated with involved margins [odds ratio (OR) 4.67]. Conclusions OBCS together with tailored WL obtains an acceptable rate of positive margins and high rate of final BCS.
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Affiliation(s)
- Fernando Hernanz
- Oncoplastic Breast Unit, Hospital Universitario Valdecilla, University of Cantabria, Santander, Spain
| | - Mónica González-Noriega
- Oncoplastic Breast Unit, Hospital Universitario Valdecilla, University of Cantabria, Santander, Spain
| | - Sonia Sánchez
- Oncoplastic Breast Unit, Hospital Universitario Valdecilla, University of Cantabria, Santander, Spain
| | - Lucia Paz
- Oncoplastic Breast Unit, Hospital Universitario Valdecilla, University of Cantabria, Santander, Spain
| | - Pedro Muñoz
- Oncoplastic Breast Unit, Hospital Universitario Valdecilla, University of Cantabria, Santander, Spain
| | - Sandra Hermana
- Oncoplastic Breast Unit, Hospital Universitario Valdecilla, University of Cantabria, Santander, Spain
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Versteegden DPA, Keizer LGG, Schlooz-Vries MS, Duijm LEM, Wauters CAP, Strobbe LJA. Performance characteristics of specimen radiography for margin assessment for ductal carcinoma in situ: a systematic review. Breast Cancer Res Treat 2017; 166:669-679. [DOI: 10.1007/s10549-017-4475-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/19/2017] [Indexed: 01/30/2023]
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Unkart JT, Chen SL, Wapnir IL, González JE, Harootunian A, Wallace AM. Intraoperative Tumor Detection Using a Ratiometric Activatable Fluorescent Peptide: A First-in-Human Phase 1 Study. Ann Surg Oncol 2017; 24:3167-3173. [PMID: 28699134 DOI: 10.1245/s10434-017-5991-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Positive surgical margins remain a significant challenge in breast cancer surgery. This report describes the use of a novel, first-in-human ratiometric activatable cell-penetrating peptide in breast cancer surgery. METHODS A two-part, multi-institutional phase 1 trial of AVB-620 with a 3+3 dose escalation and dose-expansion cohorts was conducted. The patients received an infusion of AVB-620 2-20 h before planned lumpectomy/mastectomy and sentinel node biopsy/axillary dissection. Imaging analysis was performed on images obtained from the surgical field as well as post-excision surgical specimens. Pathology reports were obtained to correlate imaging results with histopathologic data. Information on physical adverse events and laboratory abnormalities were recorded. RESULTS A total of 27 patients received infusion of AVB-620 and underwent surgical excision of breast cancer. The findings showed no adverse events or laboratory values attributable to infusion of AVB-620. The 8-mg dose was selected from the dose-escalation cohort for use with the expansion cohort based on imaging data. Region-of-interest (ROI) imaging analysis from the 8-mg cohort demonstrated measurable changes between pathology confirmed tumor-positive and tumor-negative tissue. CONCLUSION Intraoperative imaging of surgical specimens after infusion with AVB-620 allowed for real-time tumor detection. Infusion of AVB-620 is safe and may improve intraoperative detection of malignant tissue during breast cancer operations.
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Affiliation(s)
- Jonathan T Unkart
- Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | | | - Irene L Wapnir
- Department of Surgery, Stanford University, Stanford, CA, USA
| | | | | | - Anne M Wallace
- Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA.
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