An intraoperative MRI system for margin assessment in breast conserving surgery: Initial results from a novel technique

Papa, Moshe Z.; Allweis, Tanir; Karni, Tami; Sandbank, Judith; Konichezky, Miriam; Diment, Judith; Guterman, Assaf; Shapiro, Moshe; Peles, Zachi; Maishar, Roi; Gur, Assaf; Kolka, Eyal; Brem, Rachel F.

doi:10.1002/jso.24246

Cited by 22 publications

(10 citation statements)

References 33 publications

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“…Overall, to date, these methods offer a modest increase in sensitivity but have a lower specificity. 27 – 30 Intraoperative pathology analysis in the form of gross specimen analysis or frozen section is used as routine practice at a small number of high-volume institutions to assess margin status. 8 , 31 , 32 Studies have shown that intraoperative frozen section pathology assessment yields highly accurate results comparable with those of permanent pathology and significantly reduces re-excision rates.…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Full-3D Specimen Imaging for Lumpectomy Margin Assessment in Breast Cancer

Kulkarni

Schacht

et al. 2021

Ann Surg Oncol

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Background Two-dimensional (2D) specimen radiography (SR) and tomosynthesis (DBT) for breast cancer yield data that lack high-depth resolution. A volumetric specimen imager (VSI) was developed to provide full-3D and thin-slice cross-sectional visualization at a 360° view angle. The purpose of this prospective trial was to compare VSI, 2D SR, and DBT interpretation of lumpectomy margin status with the final pathologic margin status of breast lumpectomy specimens. Methods The study enrolled 200 cases from two institutions. After standard imaging and interpretation was performed, the main lumpectomy specimen was imaged with the VSI device. Image interpretation was performed by three radiologists after surgery based on VSI, 2D SR, and DBT. A receiver operating characteristic (ROC) curve was created for each method. The area under the curve (AUC) was computed to characterize the performance of the imaging method interpreted by each user. Results From 200 lesions, 1200 margins were interpreted. The AUC values of VSI for the three radiologists were respectively 0.91, 0.90, and 0.94, showing relative improvement over the AUCs of 2D SR by 54%, 13%, and 40% and DBT by 32% and 11%, respectively. The VSI has sensitivity ranging from 91 to 94%, specificity ranging from 81 to 85%, a positive predictive value ranging from 25 to 30%, and a negative predicative value of 99%. Conclusions The ROC curves of the VSI were higher than those of the other specimen imaging methods. Full-3D specimen imaging can improve the correlation between the main lumpectomy specimen margin status and surgical pathology. The findings from this study suggest that using the VSI device for intraoperative margin assessment could further reduce the re-excision rates for women with malignant disease.

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Section: Discussionmentioning

confidence: 99%

High-Resolution Full-3D Specimen Imaging for Lumpectomy Margin Assessment in Breast Cancer

Kulkarni

Schacht

et al. 2021

Ann Surg Oncol

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“…This finding likely reflects the increased concordance between surgeon and pathologist when using the intraoperative inking technique, allowing surgeons to better target the area of potential residual disease at re‐excision. While strategies for real‐time intraoperative margin assessment are being developed and are used in select institutions, they are not widely implemented; therefore, accurate margin marking and assessment remains crucial in improving outcomes in BCS. Further longitudinal studies are needed to corroborate this finding and improve the accuracy of margin assessment.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative inking is superior to suture marking for specimen orientation in breast cancer

et al. 2019

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Margin status is an important indicator of residual disease after breast‐conserving surgery (BCS). Intraoperatively, surgeons orient specimens to aid assessment of margins and guide re‐excision of positive margins. We performed a retrospective review of BCS cases from 2013 to 2017 to compare the two specimen orientation methods: suture marking and intraoperative inking. Patients with ductal carcinoma in situ, T1/T2 invasive cancer treated with BCS were included. Rates of positive margins and residual disease at re‐excision were evaluated. 189 patients underwent BCS; 83 had suture marking, 103 had intraoperative inking and 3 had un‐oriented specimens. The incidence of positive margins was 29% (24 patients) in the suture marked group and 20% (21 patients) in the intraoperative inked group (P = .18). Among the 45 patients with positive margins, 60% of tumors were stage T1, 76% were node negative, 36% were palpable with median tumor size of 1.5 cm. Residual disease was identified on re‐excision in 21% of the suture marked specimens and 57% of intraoperative inked specimens (P = .028). The incidence of residual cancer at re‐excision for positive margins was higher for intraoperatively inked versus suture marked specimens. This finding suggests that intraoperative inking is more effective at guiding re‐excision of positive margins.

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“…The above measurements were taken on a small group of 22 subjects undergoing BCT. Therefore, the results require confirmation in further studies [32].…”

Section: Radiological (Imaging) Techniquesmentioning

confidence: 92%

Current possibilities of peri-operative evaluation of the radicality of primary tumour resection in breast cancer patients treated with BCT (breast conserving treatment)

Nowikiewicz¹,

Zegarski²

2018

Nowotwory. Journal of Oncology

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In accordance with the current standards of treatment of breast cancer patients, the application of breast conserving treatment (BCT) requires a radical resection of the tumour and post-operative radiotherapy. This means the necessity of obtaining tumour-free primary resection margins, i.e. without the presence of cancer tissue. In spite of the correct pre-operative diagnostic process and appropriate surgical treatment, in about 20-30% BCT cases, the tumour resection turns out to be not radical. The necessity of performing another surgery leads to the prolongation of the overall operative time and increases costs. A histopathological evaluation of the margin of the primary tumour resection performed on an immediate basis is not a standard procedure in patients undergoing BCT. In spite of the definite limitations of this method, its application may decrease the overall rate of revision surgeries. The paper discusses some other currently available possibilities of perioperative evaluation of the radicality of primary tumour resection in breast cancer patients treated with BCT.

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An intraoperative MRI system for margin assessment in breast conserving surgery: Initial results from a novel technique

Cited by 22 publications

References 33 publications

High-Resolution Full-3D Specimen Imaging for Lumpectomy Margin Assessment in Breast Cancer

High-Resolution Full-3D Specimen Imaging for Lumpectomy Margin Assessment in Breast Cancer

Intraoperative inking is superior to suture marking for specimen orientation in breast cancer

Current possibilities of peri-operative evaluation of the radicality of primary tumour resection in breast cancer patients treated with BCT (breast conserving treatment)

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