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Cheung BHH, Co M, Lui TTN, Kwong A. Evolution of localization methods for non-palpable breast lesions: a literature review from a translational medicine perspective. TRANSLATIONAL BREAST CANCER RESEARCH : A JOURNAL FOCUSING ON TRANSLATIONAL RESEARCH IN BREAST CANCER 2024; 5:12. [PMID: 38751684 PMCID: PMC11093046 DOI: 10.21037/tbcr-23-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/27/2024] [Indexed: 05/18/2024]
Abstract
Background and Objective With an increasing number of non-palpable breast lesions detected due to improved screening, accurate localization of these lesions for surgery is crucial. This literature review explores the evolution of localization methods for non-palpable breast lesions, highlighting the translational journey from concept to clinical practice. Methods A comprehensive search of PubMed, Embase, and Scopus databases until September 2023 was conducted. Key Content and Findings Multiple methods have been developed throughout the past few decades. (I) Wire-guided localization (WGL) introduced in 1966, has become a reliable method for localization. Its simplicity and cost-effectiveness are its key advantages, but challenges include logistical constraints, patient discomfort, and potential wire migration. (II) Intraoperative ultrasound localization (IOUS) has shown promise in ensuring complete lesion removal with higher negative margin rates. However, its utility is limited to lesions visible on ultrasound (US) imaging. (III) Breast biopsy marker localization: the use of markers has improved the precision of localization without the need for wire. However, marker visibility remains a challenge despite improvements in their design. (IV) Radioactive techniques: radio-guided occult lesion localization (ROLL) and radioactive seed localization (RSL) offer flexibility in scheduling and improved patient comfort. However, they require close multidisciplinary collaboration and specific equipment due to radioactive concerns. (V) Other wireless non-radioactive techniques: wireless non-radioactive techniques have been developed in recent three decades to provide flexible and patient-friendly alternatives. It includes magnetic seed localization, radar techniques, and radiofrequency techniques. Their usage has been gaining popularity due to their safety profile and allowance of more flexible scheduling. However, their high cost and need for additional training remain a barrier to a wider adoption. Conclusions The evolution of breast lesion localization methods has progressed to more patient-friendly techniques, each with its unique advantages and limitations. Future research on patient-reported outcomes, cosmetic outcomes, breast biopsy markers and integration of augmented reality with breast lesion localization are needed.
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Affiliation(s)
- Billy Ho Hung Cheung
- Division of Breast Surgery, Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Michael Co
- Division of Breast Surgery, Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Surgery, Hong Kong Sanatorium & Hospital, Hong Kong, China
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2
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Argacha P, Cortadellas T, Acosta J, Gonzalez-Farré X, Xiberta M. Comparison of ultrasound guided surgery and radio-guided occult lesions localization (ROLL) for nonpalpable breast cancer excision. Gland Surg 2023; 12:1233-1241. [PMID: 37842539 PMCID: PMC10570981 DOI: 10.21037/gs-23-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/20/2023] [Indexed: 10/17/2023]
Abstract
Background There is little literature comparing intraoperative ultrasound (IOUS) with radio-guided occult lesions localization (ROLL) in nonpalpable invasive tumors in breast conserving surgery (BCS). There is a need to compare these two methods in terms of safety and efficacy. Methods This is an observational cohort study. All patients treated with BCS for nonpalpable invasive breast cancer using IOUS from March 2016 to March 2020 were included and compared with a historical reference control group operated on using ROLL from March 2013 to March 2017. For each detection method, the ability to locate tumors intraoperatively, tumor and surgical specimen sizes, total resection volume (TRV), optimal resection volume, excess of healthy tissue resected (ETR), margin status, re-excision rate, surgical time, complications and costs were studied. Results One hundred and fifty-eight were included, 83 with IOUS and 75 with ROLL. The mean tumor size is equivalent in both groups (11.88 mm IOUS vs. 12.29 mm ROLL, P=0.668). TRV is significantly lower with IOUS (24.92 vs. 60.32 cm3, P<0.001), and the ETR is also significantly lower in the IOUS group (21.74 vs. 58.37 cm3, P<0.001). The rate of positive margins did not differ (10.98% vs. 12.16%, P=1), nor did re-excision rate (10.98% vs. 8.11%, P=0.597). Complication rate did not differ (12.2% IOUS vs. 10.81% ROLL, P=0.808). Surgical time was shorter in IOUS (45.5 vs. 57 min, P>0.05). Conclusions IOUS in BCS for nonpalpable invasive breast cancer is more accurate than ROLL because it decreases excision volumes with the same rate of free margins and re-excision. Also, IOUS is a more efficient and comfortable technique, and just as safe as ROLL.
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Affiliation(s)
- Paula Argacha
- Department of Breast Surgical Oncology, Hospital Universitari General de Catalunya, Dexeus, Spain
| | - Tomás Cortadellas
- Department of Breast Surgical Oncology, Hospital Universitari General de Catalunya, Dexeus, Spain
| | - Juan Acosta
- Department of Obstetrics and Ginecology, Hospital Universitari General de Catalunya, Dexeus, Spain
| | | | - Manel Xiberta
- Department of Obstetrics and Ginecology, Hospital Universitari General de Catalunya, Dexeus, Spain
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3
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Veluponnar D, de Boer LL, Geldof F, Jong LJS, Da Silva Guimaraes M, Vrancken Peeters MJTFD, van Duijnhoven F, Ruers T, Dashtbozorg B. Toward Intraoperative Margin Assessment Using a Deep Learning-Based Approach for Automatic Tumor Segmentation in Breast Lumpectomy Ultrasound Images. Cancers (Basel) 2023; 15:cancers15061652. [PMID: 36980539 PMCID: PMC10046373 DOI: 10.3390/cancers15061652] [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: 01/25/2023] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
There is an unmet clinical need for an accurate, rapid and reliable tool for margin assessment during breast-conserving surgeries. Ultrasound offers the potential for a rapid, reproducible, and non-invasive method to assess margins. However, it is challenged by certain drawbacks, including a low signal-to-noise ratio, artifacts, and the need for experience with the acquirement and interpretation of images. A possible solution might be computer-aided ultrasound evaluation. In this study, we have developed new ensemble approaches for automated breast tumor segmentation. The ensemble approaches to predict positive and close margins (distance from tumor to margin ≤ 2.0 mm) in the ultrasound images were based on 8 pre-trained deep neural networks. The best optimum ensemble approach for segmentation attained a median Dice score of 0.88 on our data set. Furthermore, utilizing the segmentation results we were able to achieve a sensitivity of 96% and a specificity of 76% for predicting a close margin when compared to histology results. The promising results demonstrate the capability of AI-based ultrasound imaging as an intraoperative surgical margin assessment tool during breast-conserving surgery.
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Affiliation(s)
- Dinusha Veluponnar
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Lisanne L de Boer
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Freija Geldof
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Lynn-Jade S Jong
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marcos Da Silva Guimaraes
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - Frederieke van Duijnhoven
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Theo Ruers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Nanobiophysics, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Behdad Dashtbozorg
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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4
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Wu Q, Zhou QH, Li W, Ren TB, Zhang XB, Yuan L. Evolving an Ultra-Sensitive Near-Infrared β-Galactosidase Fluorescent Probe for Breast Cancer Imaging and Surgical Resection Navigation. ACS Sens 2022; 7:3829-3837. [PMID: 36383027 DOI: 10.1021/acssensors.2c01752] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Early diagnosis and therapy are clinically crucial in decreasing mortality from breast carcinoma. However, the existing probes have difficulty in accurately identifying the margins and contours of breast carcinoma due to poor sensitivity and specificity. There is an urgent need to develop high-sensitive fluorescent probes for the diagnosis of breast carcinoma and for differentiating tumors from normal tissues during surgery. β-Galactosidase is a significant biomarker, whose overexpression is closely associated with the progression of breast tumors. Herein, we have constructed a β-galactosidase-activated fluorescent probe NIR-βgal-2 through rational design and molecular docking engineering simulations. The probe displayed superior sensitivity (detection limit = 2.0 × 10-3 U/mL), great affinity (Km = 1.84 μM), and catalytic efficiency (kcat/Km = 0.24 μM-1 s-1) for β-galactosidase. Leveraging this probe, we demonstrated the differentiation of cancer cells overexpressing β-galactosidase from normal cells and then applied the probe for intraoperative guided excision of breast tumors. Moreover, we exhibited the application of NIR-βgal-2 for the successful resection of orthotopic breast tumors by "in situ spraying" and monitored a good prognostic recovery. This work may promote the application of enzyme-activated near-infrared fluorescent probes for the development of carcinoma diagnosis and image-guided surgery.
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Affiliation(s)
- Qian Wu
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Qian-Hui Zhou
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Wei Li
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Tian-Bing Ren
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Xiao-Bing Zhang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
| | - Lin Yuan
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, China
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Corvino A, Varelli C, Catalano F, Cocco G, Delli Pizzi A, Boccatonda A, Corvino F, Basile L, Catalano O. Use of High-Frequency Transducers in Breast Sonography. J Pers Med 2022; 12:jpm12121960. [PMID: 36556182 PMCID: PMC9786615 DOI: 10.3390/jpm12121960] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Sonography companies have recently developed high-frequency transducers (20-30 MHz) to image the skin and small joints. In this pictorial review, we present a number of settings where these probes can be usefully employed to scan the breast. These include skin abnormalities of the breast and axilla; nipple-areolar complex abnormalities; superficial breast parenchyma abnormalities; breast parenchyma abnormalities in subjects with implants; very small female breasts; peripheral areas in breasts of any size; pre-puberal breasts; male breasts; post-mastectomy chest wall; and intraoperative breast sonography. Comparatively, side-by-side images obtained with conventional breast frequencies and high frequencies are shown.
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Affiliation(s)
- Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples “Parthenope”, Via Medina 40, I-80133 Naples, Italy
- Correspondence:
| | - Carlo Varelli
- Radiology Unit, Varelli Diagnostic Institute, I-80126 Naples, Italy
| | - Fabio Catalano
- Radiology Unit, Varelli Diagnostic Institute, I-80126 Naples, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, University “G. d’Annunzio”, I-66100 Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio”, I-66100 Chieti, Italy
| | - Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, I-40010 Bologna, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, I-80131 Naples, Italy
| | - Luigi Basile
- Advanced Biomedical Sciences Department, University Federico II of Naples, I-80138 Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Varelli Diagnostic Institute, I-80126 Naples, Italy
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Guo W, Ji W, Zhang T, Xing Z, Xing F. Indocyanine Green Fluorescence–Guided Lumpectomy of Nonpalpable Breast Cancer Versus Ultrasound-Guided Excision. Surg Innov 2022; 29:573-578. [PMID: 35225072 DOI: 10.1177/15533506211039962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study was to evaluate the use of indocyanine green–guided nonpalpable breast cancer lesion localization (INBCL) and to compare it with ultrasound localization (US). Methods We retrospectively reviewed 78 consecutive patients undergoing breast-conserving surgery for nonpalpable breast cancer (NBC). Of all 78 excisions, 42 cases were guided by INBCL and 36 by US. Results The rate of clear margins was 90.5% (38/42) in the INBCL group compared to the 83.3% (30/36) in the US ( P = .548). A comparison of the margins at first excision for both INBCL and US, in the INBCL series, 92.9% (39/42) of cases had a margin less than 5 mm, whereas for US series, it was 72.2% (26/36) ( P = .033). When results of the excised tissue are taken into account, the mean specimen volume for INBCL was 58 cm3, but for US it was 73 cm3, with difference in mean volume being 15 cm3 ( P = .062). Conclusions INBCL for NBCs was more accurate than US because a smaller volume of the tissue may be excised by using the technique, without compromising margin status in nonpalpable lesions.
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Affiliation(s)
- Wenbin Guo
- The Breast Center, Department of Surgery, Dalian Central Hospital, Dalian Medical University, Dalian, China
| | - Wencai Ji
- The Breast Center, Department of Surgery, Dalian Central Hospital, Dalian Medical University, Dalian, China
| | - Tianyi Zhang
- The Breast Center, Department of Surgery, Dalian Central Hospital, Dalian Medical University, Dalian, China
| | - Zhihang Xing
- The Breast Center, Department of Surgery, Dalian Central Hospital, Dalian Medical University, Dalian, China
| | - Fei Xing
- The Breast Center, Department of Surgery, Dalian Central Hospital, Dalian Medical University, Dalian, China
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7
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Bitonto V, Ruggiero MR, Pittaro A, Castellano I, Bussone R, Broche LM, Lurie DJ, Aime S, Baroni S, Geninatti Crich S. Low-Field NMR Relaxometry for Intraoperative Tumour Margin Assessment in Breast-Conserving Surgery. Cancers (Basel) 2021; 13:cancers13164141. [PMID: 34439294 PMCID: PMC8392401 DOI: 10.3390/cancers13164141] [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: 07/19/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Breast cancer is the most diagnosed cancer for women, and clear surgical margins in breast-conserving surgery (BCS) are essential for preventing recurrence. In this study, the potential of fast field-cycling 1H-NMR relaxometry as a new tool for intraoperative margin assessment was evaluated. The technique allows the determination of the tissue proton relaxation rates as a function of the applied magnetic field on small tissue samples excised from surgical specimens, at the margins of tumour resection, prior to histopathological analysis. It was found that a good accuracy in margin assessment, i.e., a sensitivity of 92% and a specificity of 85%, can be achieved. The discriminating ability shown by the relaxometric assay relies mainly on the difference of fat/water content between healthy and tumour cells. The information obtained has the potential to support the surgeon in real-time margin assessment during BCS. Abstract As conserving surgery is routinely applied for the treatment of early-stage breast cancer, the need for new technology to improve intraoperative margin assessment has become increasingly important. In this study, the potential of fast field-cycling 1H-NMR relaxometry as a new diagnostic tool was evaluated. The technique allows the determination of the tissue proton relaxation rates (R1), as a function of the applied magnetic field, which are affected by the changes in the composition of the mammary gland tissue occurring during the development of neoplasia. The study involved 104 small tissue samples obtained from surgical specimens destined for histopathology. It was found that a good accuracy in margin assessment, i.e., a sensitivity of 92% and a specificity of 85%, can be achieved by using two quantifiers, namely (i) the slope of the line joining the R1 values measured at 0.02 and 1 MHz and (ii) the sum of the R1 values measured at 0.39 and 1 MHz. The method is fast, and it does not rely on the expertise of a pathologist or cytologist. The obtained results suggest that a simplified, low-cost, automated instrument might compete well with the currently available tools in margin assessment.
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Affiliation(s)
- Valeria Bitonto
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
| | - Maria Rosaria Ruggiero
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
| | - Alessandra Pittaro
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.P.); (I.C.)
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (A.P.); (I.C.)
| | | | - Lionel M. Broche
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (L.M.B.); (D.J.L.)
| | - David J. Lurie
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (L.M.B.); (D.J.L.)
| | - Silvio Aime
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
- IRCCS SDN, Via E. Gianturco 113, 80143 Napoli, Italy
| | - Simona Baroni
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
- Correspondence:
| | - Simonetta Geninatti Crich
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (V.B.); (M.R.R.); (S.A.); (S.G.C.)
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de Boer LL, Kho E, Van de Vijver KK, Vranken Peeters MJTFD, van Duijnhoven F, Hendriks BHW, Sterenborg HJCM, Ruers TJM. Optical tissue measurements of invasive carcinoma and ductal carcinoma in situ for surgical guidance. Breast Cancer Res 2021; 23:59. [PMID: 34022928 PMCID: PMC8141169 DOI: 10.1186/s13058-021-01436-5] [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: 10/30/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although the incidence of positive resection margins in breast-conserving surgery has decreased, both incomplete resection and unnecessary large resections still occur. This is especially the case in the surgical treatment of ductal carcinoma in situ (DCIS). Diffuse reflectance spectroscopy (DRS), an optical technology based on light tissue interactions, can potentially characterize tissue during surgery thereby guiding the surgeon intraoperatively. DRS has shown to be able to discriminate pure healthy breast tissue from pure invasive carcinoma (IC) but limited research has been done on (1) the actual optical characteristics of DCIS and (2) the ability of DRS to characterize measurements that are a mixture of tissue types. Methods In this study, DRS spectra were acquired from 107 breast specimens from 107 patients with proven IC and/or DCIS (1488 measurement locations). With a generalized estimating equation model, the differences between the DRS spectra of locations with DCIS and IC and only healthy tissue were compared to see if there were significant differences between these spectra. Subsequently, different classification models were developed to be able to predict if the DRS spectrum of a measurement location represented a measurement location with “healthy” or “malignant” tissue. In the development and testing of the models, different definitions for “healthy” and “malignant” were used. This allowed varying the level of homogeneity in the train and test data. Results It was found that the optical characteristics of IC and DCIS were similar. Regarding the classification of tissue with a mixture of tissue types, it was found that using mixed measurement locations in the development of the classification models did not tremendously improve the accuracy of the classification of other measurement locations with a mixture of tissue types. The evaluated classification models were able to classify measurement locations with > 5% malignant cells with a Matthews correlation coefficient of 0.41 or 0.40. Some models showed better sensitivity whereas others had better specificity. Conclusion The results suggest that DRS has the potential to detect malignant tissue, including DCIS, in healthy breast tissue and could thus be helpful for surgical guidance. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01436-5.
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Affiliation(s)
- Lisanne L de Boer
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Postbus 90203, 1006, Amsterdam, BE, Netherlands.
| | - Esther Kho
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Postbus 90203, 1006, Amsterdam, BE, Netherlands
| | - Koen K Van de Vijver
- Department of Pathology, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | | | - Frederieke van Duijnhoven
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Postbus 90203, 1006, Amsterdam, BE, Netherlands
| | - Benno H W Hendriks
- Philips Research, In-body Systems Group, Eindhoven, Netherlands.,Biomechanical Engineering Department, Delft University of Technology, Delft, The Netherlands
| | - Henricus J C M Sterenborg
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Postbus 90203, 1006, Amsterdam, BE, Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Theo J M Ruers
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Postbus 90203, 1006, Amsterdam, BE, Netherlands.,Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
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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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10
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Kühn F, Simon CEE, Aliyeva I, KUßMAUL J, GROß J, Schweizerhof O, Blohmer JU, Karsten MM. A German Study Comparing Standard Wire Localization With Magnetic Seed Localization of Non-palpable Breast Lesions. In Vivo 2021; 34:1159-1164. [PMID: 32354905 DOI: 10.21873/invivo.11888] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Exact localization of non-palpable breast lesions is necessary to ensure that the correct lesion is removed. Conventional methods come with several disadvantages. PATIENTS AND METHODS We compared 28 patients who underwent breast-conserving surgery for a non-palpable lesion. By surgeon choice, 14 patients were assigned to undergo magnetic seed localization and 14 underwent standard wire localization. The primary outcome was the operative time, and secondary outcome was the patient pain level. RESULTS The mean age was 52±10 (SD) years in the seed arm, and 55±13 years in the wire arm. The median time from skin incision to tumor extraction was not significantly different between the two groups. Patients in the wire localized group significantly more often reported pain during coughing/breathing, movement, and sleep. CONCLUSION Using seed localization at Charité Breast Center did not lead to a significant decrease in operative time but might allow time savings once established, while increasing patient comfort and reducing organizational burden.
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Affiliation(s)
- Friedrich Kühn
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Clinic for Gynecology with Breast Center, Berlin, Germany
| | | | - Ilhamiyya Aliyeva
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Clinic for Gynecology with Breast Center, Berlin, Germany
| | - Julia KUßMAUL
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Clinic for Gynecology with Breast Center, Berlin, Germany
| | - Jessica GROß
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Clinic for Gynecology with Breast Center, Berlin, Germany
| | - Oliver Schweizerhof
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Jens-Uwe Blohmer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Clinic for Gynecology with Breast Center, Berlin, Germany
| | - Maria Margarete Karsten
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Clinic for Gynecology with Breast Center, Berlin, Germany
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11
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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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12
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Ozmen T, Avisar E. The Impact of Advanced Image-Guided Breast Surgery and Oncoplastic Techniques on Margin Positivity in Breast Conserving Surgery. Cureus 2020; 12:e11831. [PMID: 33409073 PMCID: PMC7781498 DOI: 10.7759/cureus.11831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective Positive margins remain a significant psychological and economic burden after breast conserving surgery. The aim of this study was to test the hypothesis that advanced oncoplastic techniques as well as intraoperative integrative imaging with intraoperative ultrasound and mobile digital specimen radiography decreases positive margin rate in breast conserving surgery. Methods A single-institution retrospective review of a prospectively collected database was performed. Patients with breast neoplasms who underwent lumpectomy with or without using intraoperative integrative imaging approaches and oncoplastic techniques were included. The primary outcome was positive margin rate for each technique. Results A total of 392 patients were included in the study. The median age of the cohort was 59 years. Overall positive margin rate was 15%. Ductal carcinoma in situ (DCIS) histology and larger tumor size were associated with higher positive margin rate. Intraoperative integrative imaging significantly decreased positive margin rate (9% vs. 18%, p=0.018). Oncoplastic techniques also decreased positive margin rate from 16% to 12%, however this was not significant. Conclusion Positive margin rate was significantly lower when intraoperative integrative imaging was used. Oncoplastic techniques also decreased positive margin rate in a selected group of patients with large tumor size. We suggest incorporating these techniques in all breast conserving surgery cases.
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Affiliation(s)
- Tolga Ozmen
- Surgical Oncology, University of Miami, Miller School of Medicine, Miami, USA
| | - Eli Avisar
- Surgical Oncology, University of Miami, Miller School of Medicine, Miami, USA
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13
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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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14
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Khare S, Singh T, Santosh I, Laroiya I, Singh G. Wire- and Ultrasound-Guided Localization: A Novel Technique for Excision of Nonpalpable Breast Tumors. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2020; 14:1178223420938068. [PMID: 32669849 PMCID: PMC7336821 DOI: 10.1177/1178223420938068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/03/2022]
Abstract
Background: Excision of nonpalpable breast lesions requires intraoperative guidance.
Wire-guided localization and intraoperative ultrasounds have been used
successfully but suffer from some disadvantages. We describe a new
modification of the standard technique using a combination of preoperative
ultrasound in conjunction with standard wire-guided localization. Methods: Wire and ultrasound-guided localization (WUGL) technique was used for the
excision of nonpalpable breast lesions. Results: Sixty-nine patients with nonpalpable breast lesions were subjected to
excision using WUGL, out of whom 63 patients had a preoperative diagnosis of
invasive/noninvasive breast cancer. Six patients had a preoperative
diagnosis of benign lesions, out of which 3 patients were converted to
invasive breast cancer on final pathology. Only 1 patient had positive
margin. Conclusions: WUGL is a technique that uses a combination of well-accepted and easily
available techniques. It has given good results and has the potential for
widespread acceptance in resource-constrained situations.
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Affiliation(s)
- Siddhant Khare
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Tulika Singh
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India.,Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Irrinki Santosh
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Ishita Laroiya
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
| | - Gurpreet Singh
- Department of Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Chandigarh, India
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15
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Zeng X, Xue L, Chen D, Li S, Nong J, Wang B, Tang L, Li Q, Li Y, Deng Z, Hong X, Wu M, Xiao Y. A bright NIR-II fluorescent probe for breast carcinoma imaging and image-guided surgery. Chem Commun (Camb) 2020; 55:14287-14290. [PMID: 31712798 DOI: 10.1039/c9cc07694h] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A novel bright near-infrared II (NIR-II, 1000-1700 nm) fluorescent probe with excellent water-solubility, superior photostability, and excellent in vitro and in vivo biocompatibility was facilely synthesized for in vivo biomedical imaging of xenograft breast tumor and chemically induced spontaneous breast carcinoma. To the best of our knowledge, it is the first time that the superior practical applications of this NIR-II probe in dimethylbenzanthracene (DMBA)-induced rat mammary carcinoma imaging and image-guided rat carcinoma surgery were demonstrated.
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Affiliation(s)
- Xiaodong Zeng
- State Key Laboratory of Virology, Department Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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16
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Moiel D, Thompson J, Larsen KD. Mastectomy or Breast-Conserving Therapy: Which Factors Influence A Patient's Decision? Perm J 2019; 23:18-049. [PMID: 31314719 DOI: 10.7812/tpp/18-049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The choice between mastectomy and breast-conserving therapy (BCT) is a first step for patients with breast cancer who are confronting decisions about treatment. OBJECTIVE To identify the most important determinants in treatment decision making by patients with breast cancer. METHODS Between 2003 and 2013, a total of 5258 patients with breast cancer were recorded in Kaiser Permanente Northwest's cancer registry. Patients had similar clinical-pathologic profiles, education, and insurance coverage, and were managed by 1 surgical group. A total of 2604 patients with invasive breast cancer chose mastectomy or BCT as they met unambiguous criteria for equivalent outcomes with either option. We examined the influence of the patient's surgeon on patient preferences. RESULTS Our retrospective analyses examined a study population that had similar risk profiles (age, family history of breast cancer, T category on tumor-node-metastasis staging system, tumor size, physical examination findings), surgeons consulting on similar patient types, and managed by surgeons with similar surgical performance patterns (case volumes, reexcision rates, number of reoperations, and ability to meet patient's expectations). Patients who preferred mastectomy were strongly influenced by tumor size (p < 0.001) and abnormal physical examination findings (palpable mass; p = 0.004), rather than age, family history of breast cancer, T category, or surgeon. CONCLUSION Physical examination findings and tumor size were statistically significant determinants influencing patients to choose mastectomy. Because geographic and practice style explanations fail to explain these variations, surgeons can identify, anticipate, and consider these factors when counseling patients about mastectomy and BCT therapeutic equivalency.
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Affiliation(s)
- David Moiel
- Retired, Department of Surgery, Kaiser Permanente Northwest, Portland, OR
| | - John Thompson
- Retired, Department of Pathology, Kaiser Permanente Northwest, Portland, OR
| | - Kenneth D Larsen
- Retired, Department of Anesthesiology, Kaiser Permanente Northwest, Portland, OR
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17
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Gerrard AD, Shrotri A. Surgeon-led Intraoperative Ultrasound Localization for Nonpalpable Breast Cancers: Results of 5 Years of Practice. Clin Breast Cancer 2019; 19:e748-e752. [PMID: 31208875 DOI: 10.1016/j.clbc.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The uptake of breast screening has led to a rise in the number of nonpalpable breast cancer diagnoses. Breast conserving therapy (BCT) is the treatment of choice for early breast cancer, and this requires localization of the lesion. Commonly detection is achieved by wire-guided localization in the radiology department. This technique has complications and requires utilization of a radiologist. Intraoperative ultrasound (IOUS) has been shown to be a safe alternative, but there is little data on its use. The aim of this study is to report the use of surgeon-led IOUS over the past 5 years, assessing the ability to detect lesions and the re-excision rate for involved margins. PATIENTS AND METHODS A retrospective observational study was performed on consecutive patients undergoing IOUS-marked BCT between 2014 and 2018. The technique is described, and patients' records were reviewed to assess the histologic specimen reports and need for subsequent re-excision. RESULTS Ninety-five IOUS BCT operations were performed. Every cancer was identified by IOUS and removed. Fourteen margins were positive and required re-excision. Of these, only 2 contained residual tumor. CONCLUSION This is the first data from the United Kingdom for IOUS skin marking without wire localization. IOUS is a safe method of localization in BCT. It offers advantages both to the patient and the unit as it reduces pressure on the radiology department.
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Affiliation(s)
- Adam D Gerrard
- Breast Department, Aintree University Hospital NHS Foundation Trust, Liverpool, England
| | - Anu Shrotri
- Breast Department, Aintree University Hospital NHS Foundation Trust, Liverpool, England.
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18
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Korpan NN, Xu K, Schwarzinger P, Watanabe M, Breitenecker G, Patrick LP. Cryo-Assisted Resection En Bloc, and Cryoablation In Situ, of Primary Breast Cancer Coupled With Intraoperative Ultrasound-Guided Tracer Injection: A Preliminary Clinical Study. Technol Cancer Res Treat 2019; 17:1533034617746294. [PMID: 29347887 PMCID: PMC5784566 DOI: 10.1177/1533034617746294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of the study was to perform cryosurgery on a primary breast tumor, coupled with simultaneous peritumoral and intratumoral tracer injection of a blue dye, to evaluate lymphatic mapping. We explored the ability of our strategy to prevent tumor cells, but not that of injected tracers, to migrate to the lymphovascular drainage during conventional resection of frozen breast malignancies. Seventeen patients aged 51 (14) years (mean [standard deviation]), presenting primary breast cancer with stage I to IV, were randomly selected and treated in The Rudolfinerhaus Private Clinic in Vienna, Austria, and included in this preliminary clinical study. Under intraoperative ultrasound, 14 patients underwent curative cryo-assisted tumor resection en bloc, coupled with peritumoral tracer injection, which consisted of complete tumor freezing and concomitant peritumor injection with a blue dye, before resection and sentinel lymph node dissection (group A). Group B consists of 3 patients previously refused any standard therapy and had palliative tumor cryoablation in situ combined with intratumoral tracer injection. The intraoperative ultrasound facilitated needle positioning and dye injection timing. In group A, the frozen site extruded the dye that was distributed through the unfrozen tumor, the breast tissue, and the resection cavity for 12 patients. One to 4 lymph nodes were stained for 10 of 14 patients. The resection margin was evaluable. Our intraoperative ultrasound-guided performance revealed the injection and migration of a blue dye during the frozen resection en bloc and cryoablation in situ of primary breast tumors. Sentinel lymph node mapping, pathological determination of the tumor, and resection margins were achievable. The study paves the way for intraoperative cryo-assisted therapeutic strategies for breast cancer.
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Affiliation(s)
- Nikolai N Korpan
- 1 International Institute of Cryosurgery, The Rudolfinerhaus Private Clinic, Vienna, Austria.,2 1st Department of Surgery, National Medical University, Kyiv, Ukraine
| | - Kecheng Xu
- 2 1st Department of Surgery, National Medical University, Kyiv, Ukraine.,3 Jinan University School of Medicine, Fuda Cancer Hospital, Guangzhou, China
| | | | | | - Gerhard Breitenecker
- 6 Pathologic-Histological Central Laboratory, The Rudolfinerhaus Private Clinic, Vienna, Austria
| | - Le Pivert Patrick
- 7 Interventional Drug Delivery Systems and Strategies, Jupiter, FL, USA
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19
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Carlino G, Rinaldi P, Giuliani M, Rella R, Bufi E, Padovano F, Ciardi C, Romani M, Belli P, Manfredi R. Ultrasound-guided preoperative localization of breast lesions: a good choice. J Ultrasound 2018; 22:85-94. [PMID: 30367356 DOI: 10.1007/s40477-018-0335-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 10/11/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The aim of the study was to verify whether ultrasound (US)-guided preoperative localization of breast lesions is an adequate technique for correct and safe surgical resection and to contribute positively and effectively to this topic in the literature with our results. METHODS From June 2016 to November 2016, 155 patients with both benign and malignant breast lesions were selected from our institute to undergo US localization before surgery. The lesions included were: sonographically visible and nonpalpable lesions; palpable lesions for which a surgeon had requested US localization to better evaluate the site and extension; sonographically visible, multifocal breast lesions, both palpable and nonpalpable. US localization was performed using standard linear transducers (Siemens 18 L6, 5.5-8 MHz, 5.6 cm, ACUSON S2000 System, Siemens Medical Solutions). The radiologist used a skin pen to mark the site of the lesion, and the reported lesion's depth and distance from the nipple and pectoral muscle were recorded. The lesions were completely excised by a team of breast surgeons, and the surgical specimens were sent to the Radiology Department for radiological evaluation and to the Pathology Department for histological assessment. RESULTS In 155 patients who underwent to preoperative US localization, 188 lesions were found, and the location of each lesion was marked with a skin pen. A total of 181 lesions were confirmed by the final histopathologic exam (96.28%); 132 of them (72.92%) were malignant, and 124 of these (93.93%) showed free margins. CONCLUSIONS US-guided preoperative localization of sonographically visible breast lesions is a simple and nontraumatic procedure with high specificity and is a useful tool for obtaining accurate surgical margins.
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Affiliation(s)
- Giorgio Carlino
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Pierluigi Rinaldi
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Michela Giuliani
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Rossella Rella
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Enida Bufi
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Federico Padovano
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Chiara Ciardi
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maurizio Romani
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Paolo Belli
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Manfredi
- Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
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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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21
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Zhong R, Liang B, Xin R, Zhu X, Liu Z, Chen Q, Hou Y, Jin Z, Qi M, Ma S, Liu X. Deoxycytidine kinase participates in the regulation of radiation-induced autophagy and apoptosis in breast cancer cells. Int J Oncol 2018; 52:1000-1010. [PMID: 29393406 DOI: 10.3892/ijo.2018.4250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/04/2018] [Indexed: 11/05/2022] Open
Abstract
Deoxycytidine kinase (dCK) is a rate limiting enzyme critical for the phosphorylation of endogenous deoxynucleosides and for the anti‑tumor activity of many nucleoside analogs. dCK is activated in response to ionizing radiation (IR) and it is required for the G2/M checkpoint induced by IR. However, whether dCK plays a role in radiation-induced autophagy and apoptosis is less clear. In this study, we reported that dCK decreased IR-induced total cell death and apoptosis, and increased IR-induced autophagy in SKBR3 and MDA‑MB‑231 breast cancer cell lines. A molecular switch exists between apoptosis and autophagy. We further demonstrated that serine 74 phosphorylation was required for the regulation of autophagy. In dCK wild‑type (WT) or dCK S74E (mutant) MDA‑MB‑231 cell models, the expression levels of phospho-Akt, phospho-mammalian target of rapamycin (mTOR) and phospho-P70S6K significantly decreased following exposure to IR. Moreover, the ratio of Bcl‑2/Beclin1 (BECN1) significantly decreased in the S74E mutant cells; however, no change was observed in the ratio of Bcl‑2/BAX. Taken together, our findings indicate that phosphorylated and activated dCK inhibits IR-induced total cell death and apoptosis, and promotes IR-induced autophagy through the mTOR pathway and by inhibiting the binding of Bcl‑2 protein to BECN1.
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Affiliation(s)
- Rui Zhong
- Cancer Translational Medicine Laboratory, Jilin Provincial Cancer Hospital, Changchun, Jilin 130012, P.R. China
| | - Bing Liang
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Rui Xin
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xuanji Zhu
- Medical Records Room, The First Hospital Affiliated to Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhuo Liu
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Qiao Chen
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yufei Hou
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhao Jin
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Mu Qi
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shumei Ma
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaodong Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
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Ultrasound-guided wire localisation to facilitate removal of an abnormal neck lymph node - a technical note. The Journal of Laryngology & Otology 2017; 131:827-829. [PMID: 28718395 DOI: 10.1017/s0022215117001463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ultrasound-guided wire localisation is a technique that is well established in breast surgery, but is not well described in head and neck practice. It can be used to locate impalpable lesions for surgical removal, without the need for more extensive surgery. METHOD This paper describes a case where the technique was used to assist in the removal of an impalpable but radiologically abnormal lymph node. CONCLUSION The technique offers a safe and effective method for removing lesions within the head and neck.
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Burroughs J, Fencl JL, Wakefield MC. Radioactive Seed Localization Program for Patients With Nonpalpable Breast Lesions. AORN J 2017; 105:593-604. [PMID: 28554356 DOI: 10.1016/j.aorn.2017.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/28/2016] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Abstract
Without early diagnosis and treatment, many lives are lost to breast cancer. Increased breast cancer awareness has facilitated research to guide health care providers toward improving patient outcomes. Research in diagnostic and treatment modalities has expanded to focus on improving the quality of life for patients with breast cancer who are living longer than expected. Providers can offer patients with nonpalpable breast lesions new screening techniques and improved treatment options, including radioactive seed localization lumpectomy. This treatment offers patients the potential for decreased tumor re-excision for positive margins near the surgical site, a lower volume of excised breast tissue, decreased operative time, convenient surgical scheduling, and less pain. Additionally, radioactive seed localization lumpectomy can improve patient and staff member satisfaction.
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Utilization of iron (III)-doped nanoshells for in vivo marking of nonpalpable tumors using a VX2 rabbit model. Am J Surg 2016; 212:1140-1146. [PMID: 27776757 DOI: 10.1016/j.amjsurg.2016.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/09/2016] [Accepted: 09/10/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND We aimed to evaluate the potential for ultrasound (US) visible biodegradable nanoshells (NS) as an alternative to wire-guided localization for nonpalpable tumors in vivo. METHODS VX2 tumor was injected in bilateral thighs of 22 New Zealand rabbits and after 5 to 10 days, 1 tumor was marked with a wire as a control and the contralateral tumor was injected with 1 mL of 500 nm gas-filled silica NS under Doppler US. Tumors were excised after 24 hours. Chi-square was used for significance, P = .05. RESULTS One rabbit was excluded on postoperative day 1 due to equipment failure, no ill effects were observed from the NS. The NS were used to localize and resect 100% of marked tissue, 4/21 wires were displaced (P < .05). CONCLUSIONS We have shown that preoperatively injected US visible silica NS can be successfully used to mark nonpalpable tumors in vivo more consistently than WL.
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Ultrasound-guided breast-conserving surgery for early-stage palpable and nonpalpable invasive breast cancer: decreased excision volume at unchanged tumor-free resection margin. Breast Cancer Res Treat 2016; 158:535-41. [PMID: 27444926 DOI: 10.1007/s10549-016-3914-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/14/2016] [Indexed: 01/08/2023]
Abstract
Ultrasound guidance (USG) during breast-conserving surgery improves tumor-free surgical resection margins. The objective of this study was to evaluate whether USG reduces resection volumes without compromising margin status. 134 patients with palpable or nonpalpable T1-2N0-1 invasive breast cancer were treated with USG and compared with a historical reference control group (CON) consisting of palpation-guided (PAG) or wire-guided localization (WIG) breast-conserving surgery. Primary outcomes were excess resection volume and clear margin status, and secondary outcome was re-excision rate. 66 patients underwent USG. In the CON group (n = 68), PAG was performed in 24 (35 %) and WIG in 44 (64 %) patients. Median excision volume [39 (IQR 20-66) vs 56 (38-94) cm(3); p = 0.001] and median calculated resection ratio [1.7 (1.0-2.9) vs 2.8 (1.4-4.6) (p = 0.005)] were significantly smaller in the USG than in the CON group. Median minimal distance to the resection margin [4 mm (IQR 2-5 mm) vs 2 mm (1-4 mm), p = 0.004] was significantly larger. Clear resection margins were achieved in 58 of the USG patients (88 %) and in 58 of the CON patients (86 %) (p = 0.91); this was true in patients with palpable as well as nonpalpable lesions. Reexcision was needed in 6.1 and 7.2 % respectively. Relative risk for re-excision in the USG group was 0.82 (95 % CI 0.23-2.93). In patients with palpable and nonpalpable breast cancers, USG allows for lower excision volume and reduced resection of healthy breast tissue, without increased re-excision rate.
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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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