Predictors of re‐excision in wire‐guided wide local excision for early breast cancer: a <scp>W</scp>estern <scp>A</scp>ustralian multi‐centre experience

Ballal, Helen; Taylor, Donna; Bourke, Anita G.; Latham, Bruce; Saunders, Christobel

doi:10.1111/ans.13067

Cited by 23 publications

(22 citation statements)

References 45 publications

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“…Enabling surgeons to accurately assess the surgical margin and/or the breast cavity during breast‐conserving surgery may enable more effective removal of tumor . This could potentially reduce the number of patients requiring additional procedures, currently 20% to 30% . A number of techniques have been utilized for intraoperative surgical margin assessment, including frozen section histology, imprint cytology, intraoperative ultrasound and intraoperative specimen radiography; however, these techniques have not significantly reduced re‐excision rates .…”

Section: Introductionmentioning

confidence: 99%

Optical palpation for the visualization of tumor in human breast tissue

Allen

Wijesinghe

Dessauvagie

et al. 2018

Journal of Biophotonics

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Accurate and effective removal of tumor in one operation is an important goal of breast-conserving surgery. However, it is not always achieved. Surgeons often utilize manual palpation to assess the surgical margin and/or the breast cavity. Manual palpation, however, is subjective and has relatively low resolution. Here, we investigate a tactile imaging technique, optical palpation, for the visualization of tumor. Optical palpation generates maps of the stress at the surface of tissue under static preload compression. Stress is evaluated by measuring the deformation of a contacting thin compliant layer with known mechanical properties using optical coherence tomography. In this study, optical palpation is performed on 34 freshly excised human breast specimens. Wide field-of-view (up to ~46 × 46 mm) stress images, optical palpograms, are presented from four representative specimens, demonstrating the capability of optical palpation to visualize tumor. Median stress reported for adipose tissue, 4 kPa, and benign dense tissue, 8 kPa, is significantly lower than for invasive tumor, 60 kPa. In addition, we demonstrate that optical palpation provides contrast consistent with a related optical technique, quantitative micro-elastography. This study demonstrates that optical palpation holds promise for visualization of tumor in breast-conserving surgery.

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Section: Introductionmentioning

confidence: 99%

Optical palpation for the visualization of tumor in human breast tissue

Allen

Wijesinghe

Dessauvagie

et al. 2018

Journal of Biophotonics

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“…If no tumor is found on the cut edge or within the margin, it is classified as a negative margin. Currently, ~20 -30% of patients undergo a re-excision procedure to remove additional tissue due to detection of an involved (positive or close) margin [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Wide-field optical coherence micro-elastography for intraoperative assessment of human breast cancer margins

Allen

Chin

Wijesinghe

et al. 2016

Biomed. Opt. Express

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Incomplete excision of malignant tissue is a major issue in breast-conserving surgery, with typically 20 -30% of cases requiring a second surgical procedure arising from postoperative detection of an involved margin. We report advances in the development of a new intraoperative tool, optical coherence micro-elastography, for the assessment of tumor margins on the micro-scale. We demonstrate an important step by conducting whole specimen imaging in intraoperative time frames with a wide-field scanning system acquiring mosaicked elastograms with overall dimensions of ~50 × 50 mm, large enough to image an entire face of most lumpectomy specimens. This capability is enabled by a wide-aperture annular actuator with an internal diameter of 65 mm. We demonstrate feasibility by presenting elastograms recorded from freshly excised human breast tissue, including from a mastectomy, lumpectomies and a cavity shaving. Vitkin, "Hybrid method of strain estimation in optical coherence elastography using combined sub-wavelength phase measurements and supra-pixel displacement tracking," J. Biophotonics 9(5), 499-509 (2016

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“…Final margin assessment is, however, generally only available postoperatively, from histopathological examination performed days after the surgery. It is reported that 20–30% of patients undergoing breast‐conserving surgery require a second surgery due to insufficient (known as positive) margins . Existing intraoperative assessment methods include frozen‐section histology, and imprint cytology; however, these methods are not widely used, typically add 25–35 min to the operating time, and are limited to assessing only a small portion of the margin .…”

Section: Introductionmentioning

confidence: 99%

Simplifying the assessment of human breast cancer by mapping a micro‐scale heterogeneity index in optical coherence elastography

Chin

Latham

Saunders

et al. 2016

Journal of Biophotonics

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Surgical treatment of breast cancer aims to identify and remove all malignant tissue. Intraoperative assessment of tumor margins is, however, not exact; thus, re‐excision is frequently needed, or excess normal tissue is removed. Imaging methods applicable intraoperatively could help to reduce re‐excision rates whilst minimizing removal of excess healthy tissue. Optical coherence elastography (OCE) has been proposed for use in breast‐conserving surgery; however, intraoperative interpretation of complex OCE images may prove challenging. Observations of breast cancer on multiple length scales, by OCE, ultrasound elastography, and atomic force microscopy, have shown an increase in the mechanical heterogeneity of malignant breast tumors compared to normal breast tissue. In this study, a micro‐scale mechanical heterogeneity index is introduced and used to form heterogeneity maps from OCE scans of 10 ex vivo human breast tissue samples. Through comparison of OCE, optical coherence tomography images, and corresponding histology, malignant tissue is shown to possess a higher heterogeneity index than benign tissue. The heterogeneity map simplifies the contrast between tumor and normal stroma in breast tissue, facilitating the rapid identification of possible areas of malignancy, which is an important step towards intraoperative margin assessment using OCE.

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Predictors of re‐excision in wire‐guided wide local excision for early breast cancer: a Western Australian multi‐centre experience

Cited by 23 publications

References 45 publications

Optical palpation for the visualization of tumor in human breast tissue

Optical palpation for the visualization of tumor in human breast tissue

Wide-field optical coherence micro-elastography for intraoperative assessment of human breast cancer margins

Simplifying the assessment of human breast cancer by mapping a micro‐scale heterogeneity index in optical coherence elastography

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