Assessment of Surgeon Factors Associated With Margin Re-excision After Breast-Conserving Surgery

Chakedis, Jeffery; Chang, Sharon B.; Tang, Annie; Kuehner, Gillian; Savitz, Alison; Vuong, Brooke; Kavanagh, Maihgan A.

doi:10.1001/jamanetworkopen.2022.28100

Cited by 3 publications

(2 citation statements)

References 5 publications

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“… 17 This is important because 20% or more of all breast-conserving surgery procedures result in margins with residual disease. 18 – 21 Because the definitive margin status is only assessed postoperatively, patients with positive margins require a second operation, which leads to additional costs, patient anxiety, and an increased risk of post-surgical complications. In the United States alone, there are 26,550 re-excisions annually, costing approximately $125M.…”

Section: Introductionmentioning

confidence: 99%

Macroscopic inelastic scattering imaging using a hyperspectral line-scanning system identifies invasive breast cancer in lumpectomy and mastectomy specimens

David,

Tavera,

Trang

et al. 2024

J. Biomed. Opt.

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Of patients with early-stage breast cancer, 60% to 75% undergo breast-conserving surgery. Of those, 20% or more need a second surgery because of an incomplete tumor resection only discovered days after surgery. An intraoperative imaging technology allowing cancer detection on the margins of breast specimens could reduce re-excision procedure rates and improve patient survival.Aim: We aimed to develop an experimental protocol using hyperspectral linescanning Raman spectroscopy to image fresh breast specimens from cancer patients. Our objective was to determine whether macroscopic specimen images could be produced to distinguish invasive breast cancer from normal tissue structures.Approach: A hyperspectral inelastic scattering imaging instrument was used to interrogate eight specimens from six patients undergoing breast cancer surgery. Machine learning models trained with a different system to distinguish cancer from normal breast structures were used to produce tissue maps with a field-of-view of 1 cm 2 classifying each pixel as either cancer, adipose, or other normal tissues. The predictive model results were compared with spatially correlated histology maps of the specimens.Results: A total of eight specimens from six patients were imaged. Four of the hyperspectral images were associated with specimens containing cancer cells that were correctly identified by the new ex vivo pathology technique. The images associated with the remaining four specimens had no histologically detectable cancer cells, and this was also correctly predicted by the instrument.Conclusions: We showed the potential of hyperspectral Raman imaging as an intraoperative breast cancer margin assessment technique that could help surgeons improve cosmesis and reduce the number of repeat procedures in breast cancer surgery.

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Section: Introductionmentioning

confidence: 99%

Macroscopic inelastic scattering imaging using a hyperspectral line-scanning system identifies invasive breast cancer in lumpectomy and mastectomy specimens

David,

Tavera,

Trang

et al. 2024

J. Biomed. Opt.

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show abstract

“… 5 As a result of these challenges, many studies report 7.8% to 50% re-excision rates in patients that underwent BCT. 7 – 10 With no internationally agreed-upon standard margin width set for BCT 11 , 12 and great variability in re-excision rates between surgeons, an intraoperative tool for margin assessment could allow for greater control of disease by providing greater information prior to pathologic examination, reducing positive margins, minimizing the need for reoperation, and morbidity.…”

Section: Introductionmentioning

confidence: 99%

Multivariate analysis of breast tissue using optical parameters extracted from a combined time-resolved fluorescence and diffuse reflectance system for tumor margin detection

Dao,

Gohla,

Williams

et al. 2023

J. Biomed. Opt.

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Breast conservation therapy is the preferred technique for treating primary breast cancers. However, breast tumor margins are hard to determine as tumor borders are often ill-defined. As such, there exists a need for a clinically compatible tumor margin detection system.Aim: A combined time-resolved fluorescence and diffuse reflectance (TRF-DR) system has been developed to determine the optical properties of breast tissue. This study aims to improve tissue classification to aid in surgical decision making.Approach: Normal and tumor breast tissue were collected from 80 patients with invasive ductal carcinoma and measured in the optical system. Optical parameters were extracted, and the tissue underwent histopathological examination. In total, 761 adipose, 77 fibroglandular, and 347 tumor spectra were analyzed. Principal component analysis and decision tree modeling were performed using only TRF optical parameters, only DR optical parameters, and using the combined datasets. Results:The classification modeling using TRF data alone resulted in a tumor margin detection sensitivity of 72.3% and specificity of 88.3%. Prediction modeling using DR data alone resulted in greater sensitivity and specificity of 80.4% and 94.0%, respectively. Combining both datasets resulted in the improved sensitivity and specificity of 85.6% and 95.3%, respectively. While both sensitivity and specificity improved with the combined modeling, further study of fibroglandular tissue could result in improved classification. Conclusion:The combined TRF-DR system showed greater tissue classification capability than either technique alone. Further work studying more fibroglandular tissue and tissue of mixed composition would develop this system for intraoperative use for tumor margin detection.

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Breast-Conserving Surgery Margin Guidance Using Micro-Computed Tomography: Challenges When Imaging Radiodense Resection Specimens

et al. 2023

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Assessment of Surgeon Factors Associated With Margin Re-excision After Breast-Conserving Surgery

Cited by 3 publications

References 5 publications

Macroscopic inelastic scattering imaging using a hyperspectral line-scanning system identifies invasive breast cancer in lumpectomy and mastectomy specimens

Macroscopic inelastic scattering imaging using a hyperspectral line-scanning system identifies invasive breast cancer in lumpectomy and mastectomy specimens

Multivariate analysis of breast tissue using optical parameters extracted from a combined time-resolved fluorescence and diffuse reflectance system for tumor margin detection

Breast-Conserving Surgery Margin Guidance Using Micro-Computed Tomography: Challenges When Imaging Radiodense Resection Specimens

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