Intra-operative assessment of excised breast tumour margins using ClearEdge imaging device

Abstract

This study shows that the CE device has potential to reduce re-excision after BCS and further randomized studies of its value are warranted.

Rapid evaporative ionisation mass spectrometry of electrosurgical vapours for the identification of breast pathology: towards an intelligent knife for breast cancer surgery

“…Both SR and IOUS guided surgery can be used directly by surgeons within the operating theatre; however neither technique is as accurate as pathological approaches and both are subject to intraobserver error [34]. A common limitation of all emerging technologies such as MarginProbe™ [23, 24], ClearEdge™ [25] or OCT [30] is the need to disrupt workflow demanding an additional probe during resection or specimen analysis following resection. Following excision, the exact orientation of the surgical specimen can prove to be challenging and this may affect accurate margin identification.…”

“…Bioimpedance is the measure of the response of tissue to an externally applied electrical current; the MarginProbe™ is quick (~5–7 minutes) and a 50% reduction in re-operation rates is achievable despite modest sensitivity and specificity (~70%) [23, 24]. Similarly, the ClearEdge™ system measures tissue-specific electrical properties with promising preliminary data (sensitivity ~85%, specificity ~80%) [25]. Optical spectroscopy techniques such as diffuse reflectance [26–28], Raman spectroscopy [29], optical coherence tomography (OCT) [30], spatial frequency domain imaging [31], fluorescence techniques [32] and confocal microscopy [33] all measure tissue response to light at various wavelengths, and whilst preliminary results are promising [34], the diagnostic accuracy of the techniques is inferior to pathological margin assessment and technological developments are required to increase image processing time and improve the ease of use.…”

Association between underestimation of tumour size by imaging and incomplete excision in breast-conserving surgery for breast cancer

“…An alternative is to use other methods of intraoperative margin assessment to identify the presence of in situ and invasive cancer close to the margins. Such devices use different methodologies, including delivering radiofrequency waves into the margin and capturing reflected signals, or bioimpedance spectroscopy which is very sensitive to extracellular and intracellular variations in dielectric tissue properties. Results have been encouraging to date, but the studies completed thus far have significant limitations.…”

Emerging Technologies for Real‐Time Intraoperative Margin Assessment in Future Breast‐Conserving Surgery

“…Regarding the new imaging methods, in this Review we introduced various techniques and trials involving OCT, [ 12 ] micro‐CT, [ 11 ] ex vivo MRI, [ 13 ] MarginProbe, [ 9 ] ClearEdge, [ 10 ] UV‐PAM, [ 14 ] MUSE, [ 15 ] a multimodal imaging technique combining tissue autofluorescence and Raman spectroscopy, [ 17 ] and chemistry‐based fluorescent methods. [ 16 ] It is essential to mention that analyzing human breast cancer tissues is more complicated compared with other cancers.…”

“…Several methods have recently emerged for real‐time intraoperative management of breast margins using live tissue. These methods include conventional specimen radiography (SR), [ 7 ] intraoperative ultrasonography (IOUSG), [ 8 ] radio‐frequency spectroscopy (MarginProbe device), [ 9 ] bioimpedance spectroscopy (ClearEdge device), [ 10 ] microcomputed tomography (micro‐CT), [ 11 ] optical coherence tomography (OCT), [ 12 ] ex vivo magnetic resonance imaging (ex vivo MRI), [ 13 ] ultraviolet photoacoustic microscopy (UV‐PAM), [ 14 ] microscopy with ultraviolet surface excitation (MUSE), [ 15 ] chemistry‐based fluorescent probes, [ 16 ] and a multimodal imaging technique combining tissue autofluorescence and Raman spectroscopy with both macro (tissue‐level) and micro (cell‐level) detection. [ 17 ]…”