Ex vivo feasibility study of endoscopic intraductal laser ablation of the breast

Boorder, Tjeerd de; Waaijer, Laurien; Diest, Paul J. van; Witkamp, Arjen J.

doi:10.1002/lsm.22745

Cited by 13 publications

(8 citation statements)

References 41 publications

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“…Continuous‐wave high power Thulium:fiber (Tm:fiber) lasers have great potential for neurosurgery due to their emitting radiation being around 2‐μm. This wavelength has been under investigation for medical applications since 2005 due to its spectral proximity to the water absorption peak , which leads to minimum collateral damage and precise tissue removal due to less penetration depth being around 500–2000 μm. Additionally, silica fibers cannot transfer laser wavelengths greater than 2‐μm , which makes Tm:fiber lasers a very attractive choice in neurosurgical applications.…”

Section: Introductionmentioning

confidence: 99%

Stereotaxic laser brain surgery with 1940‐nm Tm:fiber laser: An in vivo study

Tunç

Gülsoy

2019

Lasers Surg Med

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Background With exciting developments in fiber laser technology, studies investigating the use of lasers in neurosurgery have been increasing in the recent years. Fiber lasers are advantageous in many ways; first of all they are compact and they provide a more comfortable environment in the operating room due to feasibility of coupling laser light to different cross‐sectioned fibers. Thulium fiber (Tm:fiber) lasers have been under investigation for medical applications since 2005 due to their spectral proximity to the water absorption peak. Objectives The primary aim of this study is to investigate the thermal effects of the 1940‐nm Tm:fiber laser on subcortical tissue and to examine the effects of laser parameters on laser‐induced lesions. Secondarily, it is also aimed to reveal the importance of temperature monitoring during laser surgeries by investigating the effects of temperature change on the characteristics of laser‐induced lesions. Materials and Methods Stereotaxic laser brain surgery was performed on 20 male Wistar rats, in order to investigate the thermal effects of Tm:fiber laser. During surgeries temperature changes in the subcortical tissue were observed with a t‐type thermocouple for which a holder was designed to accomplish a 1 mm distance between the fiber tip and thermocouple tip. Histological examinations were performed on cresyl fast violet (CFV) stained slices under light microscopy. Photothermal effects of Tm:fiber laser on subcortical tissue were investigated in terms of ablated (removal of tissue), coagulated and edematous areas with a blinded micrograph evaluation. Relations between laser parameters, ablation efficiencies and rates of temperature changes were determined. Pearson's correlation coefficients between rates of temperature changes and ablation efficiencies, total laser damage and edematous area were calculated. Results No significant adverse effects were observed during surgeries. Histological examinations revealed localized ablation surrounded by coagulation areas as well as edema. Ablation efficiencies ranged from 20% to 50% with changing laser parameters. The correlation coefficient between rates of temperature change and ablation efficiencies, total laser damage and edematous area were rather high. Conclusion In this study we show that Tm:fiber lasers seem to be useful tools in brain surgeries especially to vaporize and coagulate the tissue. It is also shown that temperature monitoring during laser surgery is very crucial and gives information about laser‐induced lesion. Another take home message from this study is rather than the temperature increase, the rate of temperature change is more important. We found that if the temperature is changing in a short time interval, the extent of thermal damage can be minimized. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Stereotaxic laser brain surgery with 1940‐nm Tm:fiber laser: An in vivo study

Tunç

Gülsoy

2019

Lasers Surg Med

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“…Together with the currently being studied novel intraductal treatment modalities e.g. via intraductal targeted therapy by RNA interference [42], intraductal chemotherapy [43] or intraductal laser ablation [44], this would form an appealing approach for early detection and treatment.…”

Section: Discussionmentioning

confidence: 99%

Detection of breast cancer precursor lesions by autofluorescence ductoscopy

et al. 2020

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Purpose Autofluorescence is an image enhancement technique used for the detection of cancer precursor lesions in pulmonary and gastrointestinal endoscopy. This study evaluated the feasibility of addition of autofluorescence to ductoscopy for the detection of intraductal breast cancer precursor lesions. Methods An autofluorescence imaging system, producing real-time computed images combining fluorescence intensities, was coupled to a conventional white light ductoscopy system. Prior to surgery, ductoscopy with white light and autofluorescence was evaluated under general anaesthesia in women scheduled for therapeutic or prophylactic mastectomy. Endoscopic findings in both modes were compared, marked and correlated with histology of the surgical specimen. Results Four breast cancer patients and five high-risk women, with a median age of 47 years (range 23-62) were included. In autofluorescence mode, two intraductal lesions were seen in two breast cancer patients, which had an increase in the redto-green fluorescence intensity compared with the surrounding tissue. One lesion had initially been missed by white light ductoscopy but was clearly visible in subsequent autofluorescence mode. One endoscopic finding was classified as suspicious by white light, but was negative in autofluorescence mode and showed normal histology. Conclusions This study demonstrates for the first time the in vivo feasibility of autofluorescence ductoscopy to detect pathologically confirmed breast cancer precursor lesions in both breast cancer patients and high-risk women that were occult under white light.

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“…This addition to ductoscopy may help to detect precancerous lesions in highrisk breast cancer groups since auto-fluorescence has shown to be effective for the detection of precancerous lesions of epithelial origin (such as oesophageal, lung, bronchial and colon cancers) [48][49][50][51][52]. Additionally, the development of therapeutic options such as intraductal laser ablation further increase the utility of ductoscopy [53]. This means that there is an increasing potential for ductoscopy not only for diagnostic but also for therapeutic purposes.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported outcomes of ductoscopy procedures for pathologic nipple discharge

et al. 2020

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Background Pathologic nipple discharge (PND) is a common complaint often associated with breast cancer. However, when ultrasound and mammography are negative, the chances of malignancy are lower than 5%. Currently, major duct excision and microdochectomy are often recommended to alleviate symptoms and definitely rule out malignancy, but can cause infections and breastfeeding problems. Ductoscopy is a minimally invasive endoscopy technique that allows visualization of the mammary ducts and may not only obviate surgery but also detect malignancy. The aim of this study was to determine quality of life (QOL) after ductoscopy in patients with PND. Materials and methods All PND patients referred for ductoscopy between 2014 and 2015 to our hospital were included. Ductoscopy procedures were performed under local anaesthesia in the outpatient clinic. Patients were asked to fill out questionnaires (Breast-Q, EQ-5D-5L and SF-36) on the day of ductoscopy, and after 2 weeks, 3 and 6 months. Additionally, we performed reliability analysis to determine if these questionnaires were suitable for PND patients. Results Fifty consecutive patients underwent ductoscopy of whom 47 patients participated in this study. One domain of SF-36 (vitality) varied significantly over time. Breast-Q, SF-36 and EQ-5D-5L showed that QOL after ductoscopy for PND was unaffected by ductoscopy. Success of the ductoscopy procedure was a significant predictor for satisfaction with the result domain. Conclusion Ductoscopy is a minimally invasive technique that does not seem to impact QoL of PND patients over time. Breast-Q, SF-36 and EQ-5D-5L seem to be suitable existing QOL tests for PND patients undergoing ductoscopy, whereas SF-36 would require modifications.

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Ex vivo feasibility study of endoscopic intraductal laser ablation of the breast

Cited by 13 publications

References 41 publications

Stereotaxic laser brain surgery with 1940‐nm Tm:fiber laser: An in vivo study

Stereotaxic laser brain surgery with 1940‐nm Tm:fiber laser: An in vivo study

Detection of breast cancer precursor lesions by autofluorescence ductoscopy

Patient-reported outcomes of ductoscopy procedures for pathologic nipple discharge

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