High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

Doyle, Timothy E.; Factor, Rachel E.; Ellefson, Christina L; Sorensen, Kristina M.; Ambrose, Brady J.; Goodrich, Jeffrey B.; Hart, Vern; Jensen, Scott C.; Patel, Hemang; Neumayer, Leigh

doi:10.1186/1471-2407-11-444

Cited by 58 publications

(44 citation statements)

References 50 publications

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“…One report of ultrasound (in a range of 20 to 80 MHz) evaluated 34 samples from 17 patients and found the technique distinguished lobular carcinoma from normal tissue with specificity of 100% and sensitivity of 86%; ductal carcinoma from normal tissue with specificity of 100% and sensitivity of 74%; benign pathologies from cancer with specificity of 80% and a sensitivity of 82%; and fat necrosis from adenoma with specificity of 80% and sensitivity of 100%. 61 A more recent study of 132 patients reported a sensitivity of 44% and a specificity of 94%. This study notes that US may be a better alternative to specimen x-ray in cases of dense breasts, where x-ray has the most difficulty.…”

Section: Ultrasoundmentioning

confidence: 97%

Review of methods for intraoperative margin detection for breast conserving surgery

et al. 2018

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Breast conserving surgery (BCS) is an effective treatment for early-stage cancers as long as the margins of the resected tissue are free of disease according to consensus guidelines for patient management. However, 15% to 35% of patients undergo a second surgery since malignant cells are found close to or at the margins of the original resection specimen. This review highlights imaging approaches being investigated to reduce the rate of positive margins, and they are reviewed with the assumption that a new system would need high sensitivity near 95% and specificity near 85%. The problem appears to be twofold. The first is for complete, fast surface scanning for cellular, structural, and/or molecular features of cancer, in a lumpectomy volume, which is variable in size, but can be large, irregular, and amorphous. A second is for full, volumetric imaging of the specimen at high spatial resolution, to better guide internal radiologic decision-making about the spiculations and duct tracks, which may inform that surfaces are involved. These two demands are not easily solved by a single tool. Optical methods that scan large surfaces quickly are needed with cellular/molecular sensitivity to solve the first problem, but volumetric imaging with high spatial resolution for soft tissues is largely outside of the optical realm and requires x-ray, micro-CT, or magnetic resonance imaging if they can be achieved efficiently. In summary, it appears that a combination of systems into hybrid platforms may be the optimal solution for these two very different problems. This concept must be cost-effective, image specimens within minutes and be coupled to decision-making tools that help a surgeon without adding to the procedure. The potential for optical systems to be involved in this problem is emerging and clinical trials are underway in several of these technologies to see if they could reduce positive margin rates in BCS.

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Section: Ultrasoundmentioning

confidence: 97%

Review of methods for intraoperative margin detection for breast conserving surgery

et al. 2018

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“…Therefore, an important clinical challenge in PCa management is to devise a rapid and highly accurate method to detect cancerous cells in real time to allow resection of additional periprostatic tissues and reduce cancer recurrence after surgery. Over the last decade, several innovative analytical techniques (5)(6)(7)(8)(9)(10)(11)(12) have been developed to distinguish cancer from benign tissue in various organs. However, none has achieved wide clinical adoption for various reasons including inconvenience, narrow information content, unavailability, poor sensitivity, slowness of adoption, and operating room workflow incompatibility.…”

mentioning

confidence: 99%

Diagnosis of prostate cancer by desorption electrospray ionization mass spectrometric imaging of small metabolites and lipids

Banerjee

Zare

Tibshirani

et al. 2017

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

186

184

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Accurate identification of prostate cancer in frozen sections at the time of surgery can be challenging, limiting the surgeon's ability to best determine resection margins during prostatectomy. We performed desorption electrospray ionization mass spectrometry imaging (DESI-MSI) on 54 banked human cancerous and normal prostate tissue specimens to investigate the spatial distribution of a wide variety of small metabolites, carbohydrates, and lipids. In contrast to several previous studies, our method included Krebs cycle intermediates (m/z <200), which we found to be highly informative in distinguishing cancer from benign tissue. Malignant prostate cells showed marked metabolic derangements compared with their benign counterparts. Using the "Least absolute shrinkage and selection operator" (Lasso), we analyzed all metabolites from the DESI-MS data and identified parsimonious sets of metabolic profiles for distinguishing between cancer and normal tissue. In an independent set of samples, we could use these models to classify prostate cancer from benign specimens with nearly 90% accuracy per patient. Based on previous work in prostate cancer showing that glucose levels are high while citrate is low, we found that measurement of the glucose/citrate ion signal ratio accurately predicted cancer when this ratio exceeds 1.0 and normal prostate when the ratio is less than 0.5. After brief tissue preparation, the glucose/citrate ratio can be recorded on a tissue sample in 1 min or less, which is in sharp contrast to the 20 min or more required by histopathological examination of frozen tissue specimens.prostate cancer | Krebs cycle | metabolism | desorption electrospray ionization | mass spectrometry P rostate cancer (PCa) is the most commonly diagnosed solidorgan cancer and the second leading cause of cancer death in men in the United States (1). Because of prostate-specific antigen (PSA) screening in the United States, most PCas are discovered when they are confined to the prostate (2). Many of these localized PCas are treated by surgical removal of the entire prostate (radical prostatectomy). The presence of cancer cells at the edge of the surgical resection, or positive surgical margins, is associated with higher rates of recurrence and death from PCa (3, 4). Therefore, an important clinical challenge in PCa management is to devise a rapid and highly accurate method to detect cancerous cells in real time to allow resection of additional periprostatic tissues and reduce cancer recurrence after surgery. Over the last decade, several innovative analytical techniques (5-12) have been developed to distinguish cancer from benign tissue in various organs. However, none has achieved wide clinical adoption for various reasons including inconvenience, narrow information content, unavailability, poor sensitivity, slowness of adoption, and operating room workflow incompatibility. In PCa, intraoperative frozen sections have been used to attempt to identify PCa at the margin based on analysis of histology. However, frozen sections h...

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“…Ähnlich wie bei der akustischen Auflösung von Gewebeschichten im Ultra- [15]. Neben etlichen Invitro-und In-vivo-Untersuchungen ist eine kleine Studie von Doyle et al [7] weiter erwähnenswert, die an brusterhaltend operierten Mammakarzinompatientinnen eine direkte Korrelation zwischen den HF-Ultraschallmessungen und den Resektionsrändern zeigen konnte. Allerdings sind diese Daten aufgrund der kleinen Fallzahl und existierender Messunsicherheiten noch nicht reif.…”

Section: Optische Kohärenztomographieunclassified

Der Resektionsrand und seine Beurteilung

et al. 2015

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Der Resektionsrand und seine BeurteilungDas Mammakarzinom ist der weltweit häufigste Tumor der weiblichen Bevölkerung. Jedes Jahr werden in Europa ca. 430.000 und nach Schät-zungen des Robert-Koch-Instituts (RKI) in 2014 in Deutschland 75.200 neue Fälle diagnostiziert. Das Ziel einer jeden Operation ist die Entfernung des kompletten Tumorgewebes im Gesunden. Erfreulicherweise hat sich die Radikalität der Operation in den letzten Jahrzehnten sukzessive reduziert, da der freie Resektionsrand unter den Brustchirurgen zwar nicht immer konsensuell definiert, in jedem Fall aber weniger ausgedehnt war. Da die Nachresektionsrate durch diese Entwicklung allerdings nicht immer reduziert werden konnte, ist der Markt für Techniken zur Messung des Resektionsrandes ein stetig wachsender. Ein positiver Resektionsrandrand ist mit einer gesteigerten Lokalrezidivrate vergesellschaftet -das ist unbestritten. Allerdings wird sie auch durch die Tumorbiologie, die Wahl der adjuvanten Therapie und die Ausdehnung der jeweiligen Lä-sion beeinflusst. So ist hinreichend bekannt, dass tripel-negative und HER2-positive Mammakarzinome eine höhere Lokalrezidivrate (LRR) haben als Luminal-A/B-Karzinome [22] und dass sich eine Strahlen-und Systemtherapie güns-tig auf die Rate der lokoregionären Rezidive auswirkt.

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High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

Cited by 58 publications

References 50 publications

Review of methods for intraoperative margin detection for breast conserving surgery

Review of methods for intraoperative margin detection for breast conserving surgery

Diagnosis of prostate cancer by desorption electrospray ionization mass spectrometric imaging of small metabolites and lipids

Der Resektionsrand und seine Beurteilung

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