A device for real-time, intraoperative margin assessment in breast-conservation surgery

Karni, Tami; Pappo, Itzhak; Sandbank, Judith; Lavon, Oleg; Kent, V.; Spector, Reynold; Morgenstern, Sara; Lelcuk, Shlomo

doi:10.1016/j.amjsurg.2007.06.013

Cited by 83 publications

(50 citation statements)

References 9 publications

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“…There are two major methods of treatment: a removal of the entire breast (mastectomy) and breast-conservation surgery, where only cancerous tissue with margins of healthy tissue is removed (lumpectomy). In lumpectomy it is crucial to achieve pathologically negative margins of resection [1]. Cleanness of margins is checked in histological assignment but it is difficult to apply intra-operatively.…”

Section: Introductionmentioning

confidence: 99%

Modified open-ended dielectric probe in distinction between cancer and healthy breast tissues

Rudowski

Orzechowski

Rząca³

2010

Journal of Non-Crystalline Solids

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Section: Introductionmentioning

confidence: 99%

Modified open-ended dielectric probe in distinction between cancer and healthy breast tissues

Rudowski

Orzechowski

Rząca³

2010

Journal of Non-Crystalline Solids

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“…These methods include touch frozen section analysis (25), touch preparation cytology (26), specimen radiography (27,28), rf spectroscopy (29,30), Raman spectroscopy (31), radioguided occult lesion localization (32), near-IR fluorescence (33,34), and high-frequency ultrasound (35)(36)(37). The intraoperative application of MRI, which has been successfully applied in brain surgery (38)(39)(40)(41)(42), is limited in its application in BCS.…”

mentioning

confidence: 99%

Application of desorption electrospray ionization mass spectrometry imaging in breast cancer margin analysis

Calligaris

Caragacianu

Liu

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

216

202

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Distinguishing tumor from normal glandular breast tissue is an important step in breast-conserving surgery. Because this distinction can be challenging in the operative setting, up to 40% of patients require an additional operation when traditional approaches are used.Here, we present a proof-of-concept study to determine the feasibility of using desorption electrospray ionization mass spectrometry imaging (DESI-MSI) for identifying and differentiating tumor from normal breast tissue. We show that tumor margins can be identified using the spatial distributions and varying intensities of different lipids. Several fatty acids, including oleic acid, were more abundant in the cancerous tissue than in normal tissues. The cancer margins delineated by the molecular images from DESI-MSI were consistent with those margins obtained from histological staining. Our findings prove the feasibility of classifying cancerous and normal breast tissues using ambient ionization MSI. The results suggest that an MSbased method could be developed for the rapid intraoperative detection of residual cancer tissue during breast-conserving surgery.B reast cancer is the most commonly diagnosed carcinoma in women in the United States and Western countries. Breast conservation surgery (BCS) has become the preferred treatment option for many women with early-stage breast cancer (1). BCS entails resection of the tumor, with a clean margin of normal tissue around it. Surgery is usually followed by radiation therapy. Results from seven large randomized prospective studies, with the largest two having over 20 y of follow-up, have shown equal survival when comparing BCS coupled with whole-breast radiation and mastectomy (2, 3).Normally, breast surgeons aim to remove a patient's tumor, along with a rim of normal tissue that is free of cancer. Preoperative mammography, ultrasonography, or MRI may be used by the surgeon to guide adequate resection (4-6). Despite numerous improvements in imaging and surgical technique, the need for reexcision to achieve complete tumor resection in the United States typically ranges from 20-40% (7-15), and has been reported as being as high as 60% (16). The importance of reexcision is underscored by numerous studies, which have shown that incomplete resection of tumor and positive margins are associated with increased locoregional recurrence compared with negative margins (12,(17)(18)(19)(20). Furthermore, the landmark meta-analysis performed by the Early Breast Cancer Trialists' Collaborative Group (18, 21) directly linked local recurrence to survival, placing great emphasis on the surgeon's role in minimizing local recurrence by obtaining adequate margins.Breast tumor reexcisions are accompanied by a number of undesirable problems: The completion of therapy is delayed, infection rates are increased, cost is increased, there can be a negative psychological impact on the patient, and there can be diminished aesthetic outcomes (22-24). The development of an intraoperative technique that allows the fast and accurate ident...

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“…We would thereby like to include a review of their experience in order to compare their device with our DCP. In 2007, a study by T. Karni et al intra-operatively assessed surgical margins using the MarginProbe® [26]. The sensitivity in detecting involved margins was 71% and the specificity was 68%, depending on the width of the margin.…”

Section: Discussionmentioning

confidence: 99%

Dielectric-technique-assisted breast cancer surgery

Rząca¹,

Orzechowski²,

Wolny³

et al. 2017

Nowotwory. Journal of Oncology

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Introduction. In conservative breast cancer surgery, removing all carcinogenic lesions is a sound basis for achieving therapeutic success. The cleanness of the cutting margin is usually assessed after surgery and any residual cancerous tissue that are found, require further surgery. A simple and cheap assessment method is presented which can be used during surgery, the dielectric cancer probe (DCP), which allows the surgeon to take fast decisions on whether to extend incisions. Method. The DCP method consists of measuring and then differentiating between the electrical properties (permeability and conductivity) of healthy and cancerous breast tissue. A polyethylene strip is used to separate the examined tissue from the instrument probe and the procedure is carried out by the operating surgeon. Results. This method was found to allow correct identification of cancerous breast tissue based on taking 189 samples from 70 patients using the intraoperative hand probe. The sensitivity and specificity were respectively 87% and 99%. Conclusions. The DCP is a high sensitivity method and is totally safe for the patient and can be used intraoperatively. The device is an aid to the surgeon for differentiating between healthy and cancerous breast tissue. Its widespread use should reduce the number of reoperations in the conservative surgical management of breast cancer patients. NOWOTWORY J Oncol 2017; 67, 2: 108-114

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A device for real-time, intraoperative margin assessment in breast-conservation surgery

Cited by 83 publications

References 9 publications

Modified open-ended dielectric probe in distinction between cancer and healthy breast tissues

Modified open-ended dielectric probe in distinction between cancer and healthy breast tissues

Application of desorption electrospray ionization mass spectrometry imaging in breast cancer margin analysis

Dielectric-technique-assisted breast cancer surgery

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