Intra-operative Sonography: A Valuable Aid During Breast-Conserving Surgery for Occult Breast Cancer

Haid, A.; Knauer, Michael; Dunzinger, S; Jasarevic, Zerina; Köberle-Wührer, Roswitha; Schuster, Antonius; Toeppker, Michael; Haid, Bernhard; Wenzl, E.; Offner, Felix

doi:10.1245/s10434-007-9490-9

Cited by 76 publications

(56 citation statements)

References 56 publications

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“…Although doubts have been addressed regarding the ability of surgeons to perform breast US, previous studies have shown a high accuracy of breast US performed by surgeons. [10,11,[26][27][28][29] These findings support the conclusion that, with appropriate instruction and experience, breast surgeons can attain a level of competency that will enable them to perform US-guided BCS for palpable, and probably even impalpable, breast cancer.…”

mentioning

confidence: 53%

“…[5,10,12] Still, only one specimen showed surgical margins with DCIS. Therefore, the possible presence of tumour-associated DCIS does not justify excessively large resections to prevent intraductal margin involvement in daily practice, and will therefore not have implications for the use of intra-operative US.…”

Section: Margin Statusmentioning

confidence: 95%

“…Moreover, unexpected additional intraductal disease can often not be detected by US. [10,[23][24][25] M A N U S C R I P T…”

Section: Difficulties and Pitfallsmentioning

confidence: 99%

“…[3][4][5][6][7][8] To this end, advances have been made in image-guided breast surgery for nonpalpable breast cancer, and several studies have shown that the use of ultrasonography (US) for intraoperative tumour localisation results in the most accurate surgical excision. [9][10][11][12][13][14] In daily practice, the excision of palpable breast cancer is guided by palpation. The adequacy of this procedure is based on pre-operative imaging techniques and the experience and tactile abilities of the surgeon.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14] The increasingly more important role of breast US in the intra-operative evaluation of breast cancer calls for efforts from surgeons to perform US-guided breast procedures, particularly in settings where dedicated radiologists are not readily available at all times. Although doubts have been addressed regarding the ability of surgeons to perform breast US, previous studies have shown a high accuracy of breast US performed by surgeons.…”

mentioning

confidence: 99%

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Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Krekel

Cardozo

Müller³

et al. 2011

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. procedure, all surgeons showed proficiency in performing intra-operative breast US. Conclusion:Surgeons can easily learn the skills needed to perform intra-operative US for palpable breast tumour excision. The technique is non-invasive, simple, safe and effective for obtaining adequate resection margins. Within the first two cases, resections reached optimal volumes, thereby, presumably resulting in improved cosmetic outcomes. In a multicentre, randomised, clinical trial, intra-operative US guidance for palpable breast tumours will be evaluated for oncological ánd cosmetic outcomes. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Synopsis:This study evaluates the performance of surgeons during training for ultrasound-guided excision of palpable T1-T2 invasive breast cancer. Our findings reveal that surgeons can rapidly master intra-operative US, which is non-invasive, simple, safe and effective for obtaining adequate resection margins and excision volumes.

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mentioning

confidence: 53%

Section: Margin Statusmentioning

confidence: 95%

“…Moreover, unexpected additional intraductal disease can often not be detected by US. [10,[23][24][25] M A N U S C R I P T…”

Section: Difficulties and Pitfallsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Krekel

Cardozo

Müller³

et al. 2011

European Journal of Surgical Oncology (EJSO)

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Technique of intraoperative ultrasound‐guided excision of impalpable breast lesions

Khoo

Wong

Stephenson

et al. 2022

Australas J Ultrason Med

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The introduction of breast screening programs has led to the increased detection of occult breast lesions requiring diagnostic surgical biopsy or breast‐conserving surgery for early‐stage breast cancer. Excision of impalpable breast lesions can be challenging. Whilst a variety of techniques have now been described including the use of adjuncts such as hook wires, radioactive seeds, magnetic seeds or radiofrequency devices, many of these modalities are expensive and can be logistically problematic. The technique of surgeon‐performed ultrasound‐guided excision is a straightforward technique which is safe, cost‐efficient and avoids a painful preoperative procedure for patients such as hook wire localisation. Whilst the use of intraoperative ultrasound‐guided excision of breast lesions has been widely reported, the actual technique itself has been less well described.

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Intraoperative near‐infrared fluorescence imaging targeting folate receptors identifies lung cancer in a large‐animal model

Keating

Runge

Singhal

et al. 2016

Cancer

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Background Complete tumor resection is the most important predictor of patient survival from non-small cell lung cancer. Methods of intraoperative margin assessment following lung cancer excision are lacking. We evaluated near-infrared intraoperative imaging using a folate-targeted molecular contrast agent (OTL0038) for localization of primary lung adenocarcinoma, lymph node sampling, and margin assessment. Methods Ten dogs with lung cancer underwent either video-assisted thoracoscopic surgery (VATS) or open thoracotomy and tumor excision following intravenous injection OTL0038. Lungs were imaged using a NIR imaging device both in vivo and ex vivo. The wound bed was re-imaged for retained fluorescence suspicious for positive tumor margins. Tumor signal-to-background ratio (SBR) was measured in all cases. Next, three human patients were enrolled in a proof-of-principle study. Tumor fluorescence was measured both in situ and ex vivo. Results All canine tumors fluoresced in situ (Fluoptics mean SBR 5.2 (range 2.7-8.1); Karl Storz mean SBR 2.9 (range 1.4-2.6). Additionally, fluorescence was consistent with tumor margins on pathology. Three positive lymph nodes were discovered using NIR imaging. Also, a positive retained tumor margin was discovered upon NIR imaging of the wound bed. Human pulmonary adenocarcinomas were also fluorescent both in situ and ex vivo (mean SBR > 2.0). Conclusions NIR imaging identifies lung cancer in a large animal model. Additionally, NIR imaging can discriminate lymph nodes harboring cancer cells and also bring attention to a positive tumor margin. In humans, pulmonary adenocarcinomas fluoresce after injecting the targeted contrast agent.

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Intra-operative Sonography: A Valuable Aid During Breast-Conserving Surgery for Occult Breast Cancer

Abstract: Intra-operative sonography proved to be a reliable and helpful tool in the hands of the surgeon, not only for tumor localization, but also for orientation during tumor excision. It simplifies organizational work and spares the patient the discomfort of pre-operative needle localization.

Cited by 76 publications

References 56 publications

Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound – Feasibility and surgeons’ learning curve

Technique of intraoperative ultrasound‐guided excision of impalpable breast lesions

Intraoperative near‐infrared fluorescence imaging targeting folate receptors identifies lung cancer in a large‐animal model

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