Une nouvelle technique de contrôle des marges de résection au cours de la néphrectomie partielle : l’échographie ex vivo

Desmonts, A.; Tillou, X.; Gal, S. Le; Secco, M.; Orczyk, Clément; Bensadoun, H.; Doerfler, A.

doi:10.1016/j.purol.2013.05.002

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…In three studies concerning 118 cases a specificity of 100% was found. The high sensitivity in these studies (97–100%) should be considered with caution because each study only contained one positive SM [15–17]. The disadvantage of US is the user dependency, making it prone to interobserver variability.…”

Section: Discussionmentioning

confidence: 99%

MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses

et al. 2018

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Purpose To evaluate the feasibility of ex vivo 7T MRI to assess surgical margins (SMs) and pseudocapsule (PC) features after partial nephrectomy (PN). Materials and methods In this prospective, IRB-approved study, seven patients undergoing a PN for nine tumours between November 2014 and July 2015 were included for analysis after obtaining informed consent. MRI of the specimen was acquired using a 7T small bore scanner. The imaging protocol consisted of anatomical T1-, T2-and diffusion-weighted imaging. After formalin fixation, specimens were cut for pathology work-up in the same orientation as the MR images were obtained. The entire specimen was processed into H&E slides that were digitally scanned, annotated and correlated with radiological findings for negative SMs, PC presence, PC continuity and extra-PC-extension (EPCE). Sensitivity and specificity of MRI for assessment of these endpoints were calculated. Results The sensitivity and specificity for assessment of the SM were 100% and 75%, respectively. Two falsepositive outcomes were reported, both in case of EPCE and a SM ≤0.5 mm. For the presence of a PC, sensitivity and specificity were 100% and 33%, respectively. Two false-positive scans with anatomical structures mimicking the presence of a PC occurred. If a PC was present, continuity and EPCE were assessed with a sensitivity and specificity of 75% and 100% and 67% and 100%, respectively. Conclusion Ex vivo 7T MRI is a feasible tool for perioperative evaluation of SMs, and if present, PC features after PN. This may facilitate maximal sparing of renal parenchyma without compromising oncological outcomes. Key Points • Ex vivo MRI may contribute to improvement of negative surgical margins during partial nephrectomy.• Due to the assessment of surgical margins within a limited time span from obtaining the partial nephrectomy specimen, surgery for more complex tumours is possible with maximum sparing of healthy renal parenchyma without compromising oncological outcomes.• The intra operative assessment of pseudocapsule continuity along the resection margin enables maximal sparing of healthy renal parenchyma without delayed diagnosis of incomplete resection.

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Section: Discussionmentioning

confidence: 99%

MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses

et al. 2018

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“…Intraoperative ultrasonography has long been used as an intraoperative imaging technique for tumor localization and delineation during PN, but because the probe stays in contact with the tissue, it is not practical for real-time guidance during resection, and only a few studies report on the intraoperative assessment of surgical margins within the United States. [17][18][19][20] For these studies, ultrasonography performed intraoperatively during PN identified NSMs with 100% sensitivity and 97% to 100% specificity when compared with the final histopathological examination. [17][18][19][20] While near-infrared (NIR) fluorescence is useful for assessing the surgical cavity and assessing tissue perfusion, the technology has limited tissue penetration depth and requires contrast agents, which can be problematic due to patient intolerance and impact on surgical workflows.…”

mentioning

confidence: 99%

“…[17][18][19][20] For these studies, ultrasonography performed intraoperatively during PN identified NSMs with 100% sensitivity and 97% to 100% specificity when compared with the final histopathological examination. [17][18][19][20] While near-infrared (NIR) fluorescence is useful for assessing the surgical cavity and assessing tissue perfusion, the technology has limited tissue penetration depth and requires contrast agents, which can be problematic due to patient intolerance and impact on surgical workflows. [21][22][23][24] Augmented reality, in which preoperative or intraoperative images are superimposed onto the surgical field, has shown some success differentiating between tumor and NRP.…”

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confidence: 99%

Visible near infrared reflectance molecular chemical imaging of human ex vivo carcinomas and murine in vivo carcinomas

et al. 2020

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Significance: A key risk faced by oncological surgeons continues to be complete removal of tumor. Currently, there is no intraoperative imaging device to detect kidney tumors during excision. Aim: We are evaluating molecular chemical imaging (MCI) as a technology for real-time tumor detection and margin assessment during tumor removal surgeries. Approach: In exploratory studies, we evaluate visible near infrared (Vis-NIR) MCI for differentiating tumor from adjacent tissue in ex vivo human kidney specimens, and in anaesthetized mice with breast or lung tumor xenografts. Differentiation of tumor from nontumor tissues is made possible with diffuse reflectance spectroscopic signatures and hyperspectral imaging technology. Tumor detection is achieved by score image generation to localize the tumor, followed by application of computer vision algorithms to define tumor border. Results: Performance of a partial least squares discriminant analysis (PLS-DA) model for kidney tumor in a 22-patient study is 0.96 for area under the receiver operating characteristic curve. A PLS-DA model for in vivo breast and lung tumor xenografts performs with 100% sensitivity, 83% specificity, and 89% accuracy. Conclusion: Detection of cancer in surgically resected human kidney tissues is demonstrated ex vivo with Vis-NIR MCI, and in vivo on mice with breast or lung xenografts.

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Intraoperative Imaging Techniques to Support Complete Tumor Resection in Partial Nephrectomy

Hekman

Rijpkema

Langenhuijsen

et al. 2018

European Urology Focus

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Une nouvelle technique de contrôle des marges de résection au cours de la néphrectomie partielle : l’échographie ex vivo

Cited by 5 publications

References 14 publications

MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses

MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses

Visible near infrared reflectance molecular chemical imaging of human ex vivo carcinomas and murine in vivo carcinomas

Intraoperative Imaging Techniques to Support Complete Tumor Resection in Partial Nephrectomy

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