Intraoperative radiological margin assessment in breast-conserving surgery

Ihraï, T.; Quaranta, D.; Fouché, Yves; Machiavello, Jean-Christophe; Raoust, I.; Chapellier, C.; Maestro, C.; Marcy, M.; Ferrero, Jean-­Marc; Flipo, B.

doi:10.1016/j.ejso.2014.01.002

Cited by 32 publications

(27 citation statements)

References 16 publications

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“…However, the limitations of pathological techniques, including slow turnaround times, manpower requirements, and the potential for false positive interpretation, have limited international adoption. Specimen radiology (SR) and intraoperative ultrasound (IOUS) can be used to assess margin status and can be performed within the operating theatre providing direct feedback to the surgeon without the need for specially trained personnel [19, 20]. However, compared to pathological techniques they have inferior accuracy [14], and hence do not parallel the observed reductions in re-operation rates [21].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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BackgroundRe-operation for positive resection margins following breast-conserving surgery occurs frequently (average = 20–25%), is cost-inefficient, and leads to physical and psychological morbidity. Current margin assessment techniques are slow and labour intensive. Rapid evaporative ionisation mass spectrometry (REIMS) rapidly identifies dissected tissues by determination of tissue structural lipid profiles through on-line chemical analysis of electrosurgical aerosol toward real-time margin assessment.MethodsElectrosurgical aerosol produced from ex-vivo and in-vivo breast samples was aspirated into a mass spectrometer (MS) using a monopolar hand-piece. Tissue identification results obtained by multivariate statistical analysis of MS data were validated by histopathology. Ex-vivo classification models were constructed from a mass spectral database of normal and tumour breast samples. Univariate and tandem MS analysis of significant peaks was conducted to identify biochemical differences between normal and cancerous tissues. An ex-vivo classification model was used in combination with bespoke recognition software, as an intelligent knife (iKnife), to predict the diagnosis for an ex-vivo validation set. Intraoperative REIMS data were acquired during breast surgery and time-synchronized to operative videos.ResultsA classification model using histologically validated spectral data acquired from 932 sampling points in normal tissue and 226 in tumour tissue provided 93.4% sensitivity and 94.9% specificity. Tandem MS identified 63 phospholipids and 6 triglyceride species responsible for 24 spectral differences between tissue types. iKnife recognition accuracy with 260 newly acquired fresh and frozen breast tissue specimens (normal n = 161, tumour n = 99) provided sensitivity of 90.9% and specificity of 98.8%. The ex-vivo and intra-operative method produced visually comparable high intensity spectra. iKnife interpretation of intra-operative electrosurgical vapours, including data acquisition and analysis was possible within a mean of 1.80 seconds (SD ±0.40).ConclusionsThe REIMS method has been optimised for real-time iKnife analysis of heterogeneous breast tissues based on subtle changes in lipid metabolism, and the results suggest spectral analysis is both accurate and rapid. Proof-of-concept data demonstrate the iKnife method is capable of online intraoperative data collection and analysis. Further validation studies are required to determine the accuracy of intra-operative REIMS for oncological margin assessment.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-017-0845-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…Our results demonstrate that surgeon use of intraoperative imaging (specifically specimen mammography) is a safe and effective means to guide selective cavity shave margins and lower re‐excision rates. The overall re‐excision rate of 10% in RG in our study is on the lowest end of literature on margin positivity rates . In addition, it is half the rate of a larger study which advocates for routine six cavity shave margins .…”

Section: Discussionmentioning

confidence: 50%

“…Strategies to minimize margin re‐excision optimize patient care and have the potential to reduce healthcare costs by eliminating reoperations. Current publications suggest margin positivity rates of 5‐30% . Some advocate for routine cavity shave margins, with the largest report documenting 19% margin positivity rate using this technique …”

Section: Introductionmentioning

confidence: 99%

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Radiographically guided shave margins may reduce lumpectomy re-excision rates

et al. 2018

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Minimizing margin re-excision optimizes patient care by providing appropriate oncologic resection and reducing costs. This study aims to assess margin positivity rate in two groups: shave margin based on gross specimen (control group, CG) vs shave margin based on intraoperative imaging (radiographic group, RG). A total of 182 patients who underwent lumpectomy for stage O-III breast cancer at a single institution from January 2013 to January 2014 were evaluated. There was statistically significant decrease in margin re-excision rate with intraoperative mammography but not with ultrasound. Surgeons are ideally equipped to use intraoperative imaging to guide margin excision, thus, improving care and reducing costs.

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“…Several intraoperative margin assessment tools are also becoming available with reasonable sensitivity, although they remain largely in the development stage [57][58][59][60]. One drawback to these devices is that any intraoperative margin assessment would delay closure and increase time under anesthesia.…”

Section: • • Intraoperative Margin Assessmentmentioning

confidence: 98%

Techniques for Intraoperative Radiation Therapy for Early-Stage Breast Carcinoma

et al. 2015

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Intraoperative radiation therapy (IORT) is a method of accelerated partial breast irradiation developed to replace other longer courses of radiotherapy with a single radiation session administered at the time of breast-conserving surgery. The purpose of this review is to summarize the advantages and disadvantages of breast IORT techniques that are currently available, as well to consider potential alternative techniques for breast IORT or ultra-short course breast radiotherapy. Furthermore, we highlight the published outcomes for the IORT treatment approaches including: electron therapy, superficial photon therapy and other techniques. Potential future directions of IORT are explored including novel IORT techniques utilizing intraoperative brachytherapy with in-room imaging and rapid treatment planning.

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Intraoperative radiological margin assessment in breast-conserving surgery

Cited by 32 publications

References 16 publications

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

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

Radiographically guided shave margins may reduce lumpectomy re-excision rates

Techniques for Intraoperative Radiation Therapy for Early-Stage Breast Carcinoma

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