Optimal surgical treatment of breast cancer: Implications for local control and survival

Khan, Seema A.; Eladoumikdachi, Firas

doi:10.1002/jso.21502

Cited by 11 publications

(8 citation statements)

References 110 publications

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“…They require additional operation time and a skilled on-site pathologist to correctly interpret the results. [23,24] In addition, the reliability of imprint cytology is hampered by drying, cautery, and irregularity of the tissue surface [9,25]; while frozen section analysis damages the resection specimen and is prone to artifacts and sampling errors [15,26]. Besides these techniques, measurements of electrical impedance can also be used to detect tumor tissue at the resection margin, as is done with the MarginProbe Ò (Dune Medical Devices, Paoli, Pennsylvania, USA).…”

Section: Introductionmentioning

confidence: 99%

Fat/water ratios measured with diffuse reflectance spectroscopy to detect breast tumor boundaries

Boer

Molenkamp

Bydlon

et al. 2015

Breast Cancer Res Treat

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Recognition of the tumor during breast-conserving surgery (BCS) can be very difficult and currently a robust method of margin assessment for the surgical setting is not available. As a result, tumor-positive margins, which require additional treatment, are not found until histopathologic evaluation. With diffuse reflectance spectroscopy (DRS), tissue can be characterized during surgery based on optical parameters that are related to the tissue morphology and composition. Here we investigate which optical parameters are able to detect tumor in an area with a mixture of benign and tumor tissue and hence which parameters are most suitable for intra-operative margin assessment. DRS spectra (400-1600 nm) were obtained from 16 ex vivo lumpectomy specimens from benign, tumor border, and tumor tissue. One mastectomy specimen was used with a custom-made grid for validation purposes. The optical parameter related to the absorption of fat and water (F/W-ratio) in the extended near-infrared wavelength region (~1000-1600 nm) provided the best discrimination between benign and tumor sites resulting in a sensitivity and specificity of 100 % (excluding the border sites). Per patient, the scaled F/W-ratio gradually decreased from grossly benign tissue towards the tumor in 87.5 % of the specimens. In one test case, based on a predefined F/W-ratio for boundary tissue of 0.58, DRS produced a surgical resection plane that nearly overlapped with a 2-mm rim of benign tissue, 2 mm being the most widely accepted definition of a negative margin. The F/W-ratio provided excellent discrimination between sites clearly inside or outside the tumor and was able to detect the border of the tumor in one test case. This work shows the potential for DRS to guide the surgeon during BCS.

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Section: Introductionmentioning

confidence: 99%

Fat/water ratios measured with diffuse reflectance spectroscopy to detect breast tumor boundaries

Boer

Molenkamp

Bydlon

et al. 2015

Breast Cancer Res Treat

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“…However, margin negative lumpectomy remains challenging [8,9]. Margin status is critical to success of the treatment with most studies reporting 20-40% positive margins following lumpectomy [10,11]. If a margin is positive following lumpectomy, the patient usually undergoes a second surgery to clear the margins.…”

Section: Biophotonicsmentioning

confidence: 99%

“…If a margin is positive following lumpectomy, the patient usually undergoes a second surgery to clear the margins. Positive margins not only increase risk of ipsilateral breast tumor recurrence [10,12] but also prolong the course of treatment, create additional cost and potentially affect the cosmetic result. One suggested explanation for the high positive margin rate is lack of tumor visibility during surgery [8].…”

Section: Biophotonicsmentioning

confidence: 99%

Light‐guided lumpectomy: first clinical experience

Dayton

Soot

Wolf

et al. 2011

Journal of Biophotonics

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Despite numerous advances, lumpectomy remains a challenging procedure. We report on the early use of light-guided lumpectomy. Eight patients with non-palpable breast cancer undergoing lumpectomy for biopsy-proven and radiographically identifiable cancer were enrolled in the study. An optical wire was designed that incorporated a standard hook-wire with an optical fiber. The optical wire was placed in the same manner as a standard hook-wire. During light-guided lumpectomy, an eye-safe laser illuminated the optical wire and created a sphere of light surrounding the cancer. The light was visible at the beginning of each surgery and facilitated approaching the cancer without using the wire. Dissection around the sphere of light kept the wire tip within the surgical specimen. Three of eight initial surgical specimens had focally positive margins. Additional cavity shaves were performed during five lumpectomies and resulted in negative margins in seven of eight patients. Light-guided lumpectomy is a minor change to breast conserving surgery that can be easily incorporated into clinical practice. Further investigation into the clinical benefit of light-guided lumpectomy is warranted.

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“…Following breast conservation, the strongest risk factor for local recurrence and mortality is a positive resection margin (tumor cells on ink). Therefore, if a margin is positive or close, the patient is advised to undergo re-excision surgery to achieve clear margins 7,8 . Margin status is currently evaluated post-operatively by microscopic evaluation of pathology in small, representative pieces of tissue.…”

Section: Introductionmentioning

confidence: 99%

Epithelial and Stromal Spectral Imaging for Rapid Surgical Margin Analysis

Laughney¹

2011

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Optimal surgical treatment of breast cancer: Implications for local control and survival

Cited by 11 publications

References 110 publications

Fat/water ratios measured with diffuse reflectance spectroscopy to detect breast tumor boundaries

Fat/water ratios measured with diffuse reflectance spectroscopy to detect breast tumor boundaries

Light‐guided lumpectomy: first clinical experience

Epithelial and Stromal Spectral Imaging for Rapid Surgical Margin Analysis

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