Novel imaging techniques for intraoperative margin assessment in surgical oncology: A systematic review

Heidkamp, Jan; Scholte, Mirre; Rosman, Camiel; Manohar, Srirang; Fütterer, Jurgen J.; Rovers, Maroeska M.

doi:10.1002/ijc.33570

Cited by 37 publications

(27 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Inadequate positive margin identification frequently occurs in »5% of resections of lung and kidney tumours, in »20% of resections of breast, prostate and rectal cancer and in up to 40À60% of resections of vulvar and oral cancer. 65 Although we focused on breast cancer in this study, p28 can also enter cells of other types of cancer 19 ; therefore, we envisage that our imaging approach can also be applied in the treatment of other types of cancer. Our real-time intraoperative imaging approach has the potential to positively impact the surgical treatment outcomes (e.g., morbidity, quality of life and costs) of many types of solid tumours.…”

Section: Discussionmentioning

confidence: 99%

Image-guided surgery with a new tumour-targeting probe improves the identification of positive margins

et al. 2022

View full text Add to dashboard Cite

Background Given the lack of visual discrepancy between malignant and surrounding normal tissue, current breast conserving surgery (BCS) is associated with a high re-excision rate. Due to the increasing cases of BCS, a novel method of complete tumour removal at the initial surgical resection is critically needed in the operating room to help optimize the surgical procedure and to confirm tumour-free edges.Methods We developed a unique near-infrared (NIR) fluorescence imaging probe, ICG-p28, composed of the clinically nontoxic tumour-targeting peptide p28 and the FDA-approved NIR dye indocyanine green (ICG). ICG-p28 was characterized in vitro and evaluated in multiple breast cancer animal models with appropriate control probes. Our experimental approach with multiple-validations and -blinded procedures was designed to determine whether ICG-p28 can accurately identify tumour margins in mimicked intraoperative settings.Findings The in vivo kinetics were analysed to optimize settings for potential clinical use. Xenograft tumours stably expressing iRFP as a tumour marker showed significant colocalization with ICG-p28, but not ICG alone. Imageguided surgery with ICG-p28 showed an over 6.6 £ 10 3 -fold reduction in residual normalized tumour DNA at the margin site relative to control approaches (i.e., surgery with ICG or palpation/visible inspection alone), resulting in an improved tumour recurrence rate (92% specificity) in multiple breast cancer animal models independent of the receptor expression status. ICG-p28 allowed accurate identification of tumour cells in the margin to increase the complete resection rate.Interpretation Our simple and cost-effective approach has translational potential and offers a new surgical procedure that enables surgeons to intraoperatively identify tumour margins in a real-time, 3D fashion and that notably improves overall outcomes by reducing re-excision rates.

show abstract

Section: Discussionmentioning

confidence: 99%

Image-guided surgery with a new tumour-targeting probe improves the identification of positive margins

et al. 2022

View full text Add to dashboard Cite

show abstract

“… 22 As for breast cancer, surgical margin diagnosis in breast‐conserving surgery displays inadequate sensitivity (ranging from 65.0% to 96.0%), compared with its specificity (ranging from 84.0% to 100%). 23 In other words, the current methods may be insufficiently reliable for determining the margin status, 24 and we require alternative methods to improve accuracy. Our MPM imaging may complement the conventional intraoperative rapid diagnosis and improve the rapidity.…”

Section: Discussionmentioning

confidence: 99%

Label‐free multiphoton excitation imaging as a promising diagnostic tool for breast cancer

et al. 2022

View full text Add to dashboard Cite

Histopathological diagnosis is the ultimate method of attaining the final diagnosis; however, the observation range is limited to the two‐dimensional plane, and it requires thin slicing of the tissue, which limits diagnostic information. To seek solutions for these problems, we proposed a novel imaging‐based histopathological examination. We used the multiphoton excitation microscopy (MPM) technique to establish a method for visualizing unfixed/unstained human breast tissues. Under near‐infrared ray excitation, fresh human breast tissues emitted fluorescent signals with three major peaks, which enabled visualizing the breast tissue morphology without any fixation or dye staining. Our study using human breast tissue samples from 32 patients indicated that experienced pathologists can estimate normal or cancerous lesions using only these MPM images with a kappa coefficient of 1.0. Moreover, we developed an image classification algorithm with artificial intelligence that enabled us to automatically define cancer cells in small areas with a high sensitivity of ≥0.942. Taken together, label‐free MPM imaging is a promising method for the real‐time automatic diagnosis of breast cancer.

show abstract

“…The proposed technique to assess tumoral margins is one of many novel techniques that have been proposed to increase the intraoperative identification of malignant tumor [29]. However, these techniques are characterized by inherent limitations, of which one recurring limitation is the limited penetration depth resulting in a limited assessment of the deep resection margins [8].…”

Section: Discussionmentioning

confidence: 99%

High-Resolution 18F-FDG PET/CT for Assessing Three-Dimensional Intraoperative Margins Status in Malignancies of the Head and Neck, a Proof-of-Concept

Debacker,

Schelfhout,

Brochez

et al. 2021

JCM

View full text Add to dashboard Cite

The surgical treatment of head and neck malignancies relies on the complete removal of tumoral tissue, while inadequate margins necessitate the use of adjuvant therapy. However, most positive margins are identified postoperatively as deep margins, and intraoperative identification of the deep positive margins could help achieve adequate surgical margins and decrease adjuvant therapies. To improve deep-margin identification, we investigated whether the use of high-resolution preclinical PET and CT could increase certainty about the surgical margins in three dimensions. Patients with a malignancy of the head and neck planned for surgical resection were administered a clinical activity of 4MBq/kg 18F-FDG approximately one hour prior to surgical initiation. Subsequently, the resected specimen was scanned with a micro-PET-CT imaging device, followed by histopathological assessment. Eight patients were included in the study and intraoperative PET/CT-imaging of 11 tumoral specimens and lymph nodes of three patients was performed. As a result of the increased resolution, differentiation between inflamed and dysplastic tissue versus malignant tissue was complicated in malignancies with increased peritumoral inflammation. The current technique allowed the three-dimensional delineation of 18F-FDG using submillimetric PET/CT imaging. While further optimization and patient stratification is required, clinical implementation could enable deep margin assessment in head and neck resection specimens.

show abstract

Novel imaging techniques for intraoperative margin assessment in surgical oncology: A systematic review

Cited by 37 publications

References 50 publications

Image-guided surgery with a new tumour-targeting probe improves the identification of positive margins

Image-guided surgery with a new tumour-targeting probe improves the identification of positive margins

Label‐free multiphoton excitation imaging as a promising diagnostic tool for breast cancer

High-Resolution 18F-FDG PET/CT for Assessing Three-Dimensional Intraoperative Margins Status in Malignancies of the Head and Neck, a Proof-of-Concept

Contact Info

Product

Resources

About