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

Abstract

Clean surgical margins in breast‐conserving surgery (BCS) are essential for preventing recurrence. Intraoperative pathologic diagnostic methods, such as frozen section analysis and imprint cytology, have been recognized as crucial tools in BCS. However, the complexity and time‐consuming nature of these pathologic procedures still inhibit their broader applicability worldwide. To address this situation, two issues should be considered: 1) the development of nonpathologic intraoperative diagnosis methods that have better sensitivity, specificity, speed, and cost; and 2) the promotion of new imaging algorithms to standardize data for analyzing positive margins, as represented by artificial intelligence (AI), without the need for judgment by well‐trained pathologists. Researchers have attempted to develop new methods or techniques; several have recently emerged for real‐time intraoperative management of breast margins in live tissues. These methods include conventional imaging, spectroscopy, tomography, magnetic resonance imaging, microscopy, fluorescent probes, and multimodal imaging techniques. This work summarizes the traditional pathologic and newly developed techniques and discusses the advantages and disadvantages of each method. Taking into consideration the recent advances in analyzing pathologic data from breast cancer tissue with AI, the combined use of new technologies with AI algorithms is proposed, and future directions for real‐time intraoperative margin assessment in BCS are discussed.

Cancer Surgery 2.0: Guidance by Real-Time Molecular Technologies

“…Although intraoperative histology assessment is not always routine practice, it remains the most frequently performed examination either by intraoperative frozen section analysis or touch imprint cytology [18]. In an ideal clinical scenario, an accurate diagnosis should be rendered within 5-10 min.…”

“…However, in most cases it requires 20-40 min depending on sampling procedures and care unit organization. The complete histopathological workup includes embedding in optimal cutting temperature medium, freezing and cutting into sections for best preservation of tissue morphology [18]. Direct freezing of the sample in liquid nitrogen [19] is also possible to reduce the time, but shown to reduce sensitivity by 65-78% during BCS [20].…”

Application of Acrolein Imines to Organic Synthesis, Biofunctional Studies, and Clinical Practice

“…The fluorescent images agree well with H&E stained images of the same sections when tested blindly by pathologists. Our CTS probe, which selectively labels acrolein in cells undergoing oxidative stress (such as cancer cells; Figure 9), is a useful tool to visualize cancer morphology [51] …”

Fluorescent Imaging and Multifusion Segmentation for Enhanced Visualization and Delineation of Glioblastomas Margins

“…Surgical removal of the primary cancer with or without adjuvant therapy constitutes the standard of care for the disease. Upon tumor resection, the medical expert who is performing the operation can form an abstract visual picture of the major area of malignant tissue but not the "edges" (points formulating its boundary) at a microscopic level, which might be penetrating into the surrounding region of non-malignant tissue area [1]. To ensure the adequate removal of the cancerous tissue, the protocol requires removing enough normal tissue to achieve a "clean margin" while maintaining the functionality and formation of the organ.…”