scholarly journals Clinical efficacy of intraoperative ultrasound for margin assessment in breast conserving surgery

2020 ◽  
Author(s):  
Jeeyeon Lee ◽  
Ho Yong Park ◽  
Wan Wook Kim ◽  
Chan Sub Park ◽  
Yungeun Ji ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Resection Margin ◽  
Frozen Section ◽  
Intraoperative Ultrasound ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Assessment ◽  
Clinicopathologic Characteristics ◽  
Tumor Margin ◽  
The Mean

Abstract Background: Surgical margin negativity is highly related to local recurrence of breast cancer. The authors performed this study to evaluate if specimen mammography or ultrasonography can replace the frozen section procedure for surgical margins. Methods: One-hundred fifty five patients with breast cancer were included in this study. After the surgery, the frozen biopsies were assessed in more than three different directions, and all specimens were analyzed with mammography and ultrasonography. The clinicopathologic characteristics of the patients were assessed, and closest tumor margin–resection margin distance (TM–RM distance) to the tumor was compared among specimen mammography, ultrasonography, and pathology. Results: On comparing initial cases of positive and negative margins, the mean closest TM–RM distance in specimen ultrasonography and final pathologic reports was statistically different between both groups (DCIS: p < 0.001, p = 0.006; IDC: p = 0.042, p = 0.022). Conclusion: When the closest TM–RM distance is less than 1.8 mm in specimen ultrasonography, the frozen section cannot be waived because of high risk of margin positivity. However, if the closest TM–RM distance is >4 mm in specimen ultrasonography, the frozen section can be omitted carefully because of the very low risk of margin positivity.

Intraoperative ultrasound for improvement of re-excision rates in breast-conserving surgery.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 91-91
Author(s):  
M. Knauer ◽  
P. Tschann ◽  
R. Koeberle-Wuehrer ◽  
U. Obwegeser ◽  
Z. Jasarevic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Resection Margin ◽  
Intraoperative Ultrasound ◽  
Breast Conserving Surgery ◽  
Margin Assessment ◽  
Primary Tumors ◽  
Breast Surgeon ◽  
Cheap Method ◽  
Excision Rate

91 Background: Due to improved screening for early breast cancer, the percentages of small and nonpalpable breast tumors have significantly increased during the last decades. After lumpectomy, re-excision rates of 32%-63% have been reported and the routine placement of localization needles is painful, time-consuming, and costly. In this study we investigated the value of intraoperative ultrasound (IOUS) in the hand of the breast surgeon as a fast and cheap method for potentially improving unacceptable re-excision rates. Methods: Between July 2001 and December 2010, in 773 of 1,195 breast cancer patients a breast-conserving treatment has been performed at the certified breast care center Vorarlberg (breast-conservation rate 64.7%). In 74.9% (579/773) of the tumors IOUS was performed, of which 44% were nonpalpable and 56% were insufficiently palpable, respectively. 7.5-10 MHz linear ultrasound probes were used by four breast surgeons in combination with intraoperative macroscopic resection margin assessment by the pathologist for prospective evaluation of definitive resection margin status over time. Furthermore, local recurrence rates were assessed. Results: During the study period, 579 of the included primary tumors were detected by IOUS. The metachronous re-excision rate was halved from 22% (30/135) in the period 2001-2003 to 11% (13/121) between 2008 and 2010. Between 2001 and 2010 we achieved a total re-excision rate of 13% (74/579). In 53% of re-excision specimens, no residual tumor was present, in 23% DCIS and in 24% invasive tumor was found, respectively. At a median follow-up of 56.4 months, a local recurrence rate of 1.7% was observed using our approach of IOUS combined with intraoperative margin assessment. Conclusions: IOUS in the hand of the breast surgeon proved to be a valuable, fast, and cheap method to improve metachronous re-excision rates in breast-conserving surgery. Patients can be spared the painful, costly, and time-consuming placement of a localization needle. Furthermore, tissue-sparing operations can be performed more easily and intraoperative specimen radiography can be avoided. The actual pathologic tumor size, however, is often being underestimated, especially regarding in situ cancers.

scholarly journals Breast-conserving surgery with 3D-printed surgical guide: a single-center, prospective clinical study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhen-Yu Wu ◽  
Hee Jeong Kim ◽  
Jongwon Lee ◽  
Il Yong Chung ◽  
Jisun Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Resection Margin ◽  
Ductal Carcinoma ◽  
Bilateral Breast Cancer ◽  
Tumor Resection ◽  
Breast Conserving Surgery ◽  
Patient Specific ◽  
Prospective Clinical Study ◽  
Surgical Guide ◽  
The Mean

AbstractTo facilitate precise tumor resection at the time of breast-conserving surgery (BCS), we developed and implemented a magnetic resonance imaging (MRI)-based three-dimensional-printed (3DP) breast surgical guide (BSG). This prospective cohort study was conducted at a single institution from July 2017 to February 2019 on women with breast cancer who underwent partial breast resection using patient-specific 3DP BSGs. Eighty-eight patients with invasive cancer were enrolled, of whom 1 patient had bilateral breast cancer. The mean size of the tumor long-axis on MRI before surgery was 2.8 ± 0.9 cm, and multiple tumors were observed in 34 patients. In 16 cases (18.0%), the resection margin was tumor-positive according to intraoperative frozen biopsy; all of these tumors were ductal carcinoma in situ and were re-excised intraoperatively. In 93.3% of the cases, the resection margin was tumor-free in the permanent pathology. The mean pathological tumor size was 1.7 ± 1.0 cm, and the mean distance from the tumor to the border was 1.5 ± 1.0 cm. This exploratory study showed that the tumor area on the MRI could be directly displayed on the breast when using a 3DP BSG for BCS, thereby allowing precise surgery and safe tumor removal.Trial Registration Clinical Research Information Service (CRIS) Identifier (No. KCT0002375, KCT0003043).

Harmonic scalpel versus traditional ligation in axillary dissection for breast cancer: a retrospective multivariate analysis

2020 ◽  
Vol 99 (11) ◽  
Keyword(s):  
Breast Cancer ◽  
Axillary Dissection ◽  
Harmonic Scalpel ◽  
Breast Conserving Surgery ◽  
Seroma Formation ◽  
Nodal Involvement ◽  
Single Centre ◽  
Absorbable Material ◽  
Drain Removal ◽  
The Mean

Introduction: The aim of this pilot retrospective study is to evaluate the complication rate in patients after axillary dissection comparing preparation with harmonic scalpel vs traditional ligation technique, and to analyse risk factors for complications occurrence. Methods: 144 patients with 148 axillary dissections operated in a single centre between January 2014 and 2019 were included into the study. Axillary dissection was performed using harmonic scalpel in 73 and absorbable ligations in 70 cases. Results: Seroma formation was observed in 41 patients (56.2%) in the harmonic scalpel group and in 21 patients (30.0%) in the ligations group (p=0.003). The mean period from the surgery to drain removal was 4.0 days in the harmonic scalpel group and 3.0 days in the ligations group (p<0.001). The mean amount of the drained fluid after mastectomy was 300.9 ml in the harmonic scalpel group and 168.7 ml in the ligations group (p=0.005); after breast conserving surgery, it was 241.9 ml and 107.4 ml, respectively (p =0.023). Conclusion: In comparison with traditional ligations with absorbable material, axillary dissection using harmonic scalpel significantly increases the risk of postoperative seroma formation, prolongs the time from the surgery to drain removal, and increases the amount of drained fluid.ut any suspicion of nodal involvement, hemithyroidectomy is considered to be a sufficient procedure or the method of choice, respectively.

scholarly journals Methylation of the NT5E Gene Is Associated with Poor Prognostic Factors in Breast Cancer

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 939
Author(s):  
Young Ju Jeong ◽  
Hoon Kyu Oh ◽  
Hye Ryeon Choi ◽  
Sung Hwan Park
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Methylation Status ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Receptor Expression ◽  
Gene Methylation ◽  
Clinicopathologic Characteristics ◽  
Large Tumor ◽  
The Mean

Cluster of differentiation (CD) 73, which is encoded by the NT5E gene, regulates production of immunosuppressive adenosine and is an emerging checkpoint in cancer immunotherapy. Despite the significance of CD73 in immuno-oncology, the roles of the NT5E gene methylation in breast cancer have not been well-defined yet. Therefore, we aimed to investigate the prognostic significance of the NT5E gene methylation in breast cancer. The DNA methylation status of the NT5E gene was analyzed using pyrosequencing in breast cancer tissues. In addition, the levels of inflammatory markers and lymphocyte infiltration were evaluated. The mean methylation level of the NT5E gene was significantly higher in breast cancer than in normal breast tissues. In the analysis of relevance with clinicopathologic characteristics, the mean methylation levels of the NT5E gene were significantly higher in patients with large tumor size, high histologic grade, negative estrogen receptor expression, negative Bcl-2 expression, and premenopausal women. There was no difference in disease-free survival according to the methylation status of the NT5E gene. We found that the NT5E gene methylation was related to breast cancer development and associated with poor prognostic factors in breast cancer. Our results suggest that the NT5E gene methylation has potential as an epigenetic biomarker in breast cancer.

Clinical efficacy of intraoperative ultrasound for margin assessment in breast‐conserving surgery

2020 ◽  
Vol 26 (11) ◽  
pp. 2308-2311
Author(s):  
Jeeyeon Lee ◽  
Ho Yong Park ◽  
Wan Wook Kim ◽  
Chan Sub Park ◽  
Yungeun Ji ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Intraoperative Ultrasound ◽  
Breast Conserving Surgery ◽  
Margin Assessment

Optimizing Clinical Management of Surgical Margins in Breast-Conserving Therapy for Breast Cancer

2013 ◽  
pp. 66-71
Author(s):  
Stephen R. Grobmyer ◽  
Michael S. Cowher ◽  
Joseph P. Crowe
Keyword(s):  
Breast Cancer ◽  
Retrospective Studies ◽  
Tumor Biology ◽  
Surgical Margin ◽  
Breast Conserving Therapy ◽  
Surgical Margins ◽  
Margin Assessment ◽  
Margin Width ◽  
Definition Of ◽  
Made In

There has been, and continues to be, significant controversy over the definition of an “optimal” surgical margin in breast-conserving therapy (BCT). The historic basis of this controversy stems from the original trials documenting the safety of BCT and many conflicting retrospective studies that have sought to define the association between surgical margin width and outcomes over the last 20 years. It is important to understand that margin assessment is an inexact science, and current laboratory approaches to surgical-margin assessment represent only a sampling of the surgical margin. Currently available evidence suggests that decisions regarding surgical margins in BCT should be made in the context of what is known about the biology of breast cancer, as well the interactions of tumor biology, adjuvant treatment for breast cancer, and outcomes. Achieving consensus on management of surgical margins in BCT should be a clinical priority as it offers the opportunity to reduce the burden of breast cancer treatment on patients without compromising cancer-related outcomes.

Macroscopic Evaluation of the Trimmed Frozen Block Is a Helpful Tool for Intraoperative Assessment of Resection Margins of Breast Cancer Specimens

2018 ◽  
Vol 26 (8) ◽  
pp. 693-700
Author(s):  
Mafalda Trippel ◽  
Julia Slotta-Huspenina ◽  
Karen Becker ◽  
Tilman Rau ◽  
Stefan Paepke ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Resection Margin ◽  
Frozen Section ◽  
Final Diagnosis ◽  
Resection Margins ◽  
Additional Tool ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Intraoperative Margin Assessment

Introduction. The evaluation of the trimming surfaces (TS) of tissue blocks from frozen sections may serve as a supplementary examination tool for the intraoperative determination of resection margins of breast cancer specimens. This study aimed at the investigation of the feasibility and reliability of this technique, which has been described only very rarely in literature. Methods. Two observers assessed digital images from TS obtained from 57 resection margins. Findings were correlated with the diagnosis of the frozen section (FS) alone and the final diagnosis on formalin-fixed paraffin-embedded (FFPE) material. Results. The determination of the resection margin on TS was estimated as feasible for all cases. Interobserver congruence rate for TS was 96% (κ = 0.81), which was lower compared with FFPE (100%, κ = 1.0) but superior to FS (89%, κ = 0.67). Intraobserver congruence of the 2 reviewers was 96.5% and 93.0% between TS and FFPE, and 91.1% and 92.5% between FS and FFPE, respectively. The combination of both intraoperative consultation techniques showed similar congruence but a slight improvement for the sensitivity (0.75 to 0.875) for the diagnosis of tumor at the resection margin in FFPE for Reviewer 1 but was unchanged for Reviewer 2. Conclusion. The additional evaluation of TS can be a helpful additional tool for intraoperative margin assessment of breast cancer specimens, in particular, when processing artifacts of FS are encountered.

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