13 March 2014 Method and device for intraoperative imaging of lumpectomy specimens to provide feedback to breast surgeon for prompt re-excision during the same procedure
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Abstract
Breast conserving therapy (BCT) of breast cancer is now widely accepted due to improved cosmetic outcome and improved patients’ quality of life. One of the critical issues in performing breast-conserving surgery is trying to achieve microscopically clear surgical margins while maintaining excellent cosmesis. Unfortunately, unacceptably close or positive surgical margins occur in at least 20-25% of all patients undergoing BCT requiring repeat surgical excision days or weeks later, as permanent histopathology routinely takes days to complete. Our aim is to develop a better method for intraoperative imaging of non-palpable breast malignancies excised by wire or needle localization. Providing non-deformed three dimensional imaging of the excised breast tissue should allow more accurate assessment of tumor margins and consequently allow further excision at the time of initial surgery thus limiting the enormous financial and emotional burden of additional surgery. We have designed and constructed a device that allows preservation of the excised breast tissue in its natural anatomic position relative to the breast as it is imaged to assess adequate excision. We performed initial tests with needle-guided lumpectomy specimens using micro-CT and digital breast tomosynthesis (DBT). Our device consists of a plastic sphere inside a cylindrical holder. The surgeon inserts a freshly excised piece of breast tissue into the sphere and matches its anatomic orientation with the fiducial markers on the sphere. A custom-shaped foam is placed inside the sphere to prevent specimen deformation due to gravity. DBT followed by micro-CT images of the specimen were obtained. We confirmed that our device preserved spatial orientation of the excised breast tissue and that the location error was lower than 10mm and 10 degrees. The initial obtained results indicate that breast lesions containing microcalcifications allow a good 3D imaging of margins providing immediate intraoperative feedback for further excision as needed at the initial operation.
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Andrzej Krol, Andrzej Krol, Susan Hemingway, Susan Hemingway, Kara Kort, Kara Kort, Gustavo de la Rosa, Gustavo de la Rosa, Ravi Adhikary, Ravi Adhikary, Deepa Masrani, Deepa Masrani, David Feiglin, David Feiglin, Avice O’Connell, Avice O’Connell, Mahesh Nagarajan, Mahesh Nagarajan, Chien-Chun Yang, Chien-Chun Yang, Axel Wismüller, Axel Wismüller, } "Method and device for intraoperative imaging of lumpectomy specimens to provide feedback to breast surgeon for prompt re-excision during the same procedure", Proc. SPIE 9038, Medical Imaging 2014: Biomedical Applications in Molecular, Structural, and Functional Imaging, 90381G (13 March 2014); doi: 10.1117/12.2043919; https://doi.org/10.1117/12.2043919
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