scholarly journals Novel imaging techniques for intraoperative margin assessment in surgical oncology: a systematic review

2021 ◽  
Author(s):  
Jan Heidkamp ◽  
Mirre Scholte ◽  
Camiel Rosman ◽  
Srirang Manohar ◽  
Jurgen J. Fütterer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Imaging Techniques ◽  
Surgical Oncology ◽  
Margin Assessment ◽  
Intraoperative Margin Assessment

Systematic review and meta-analysis of the diagnostic accuracy of intraoperative margin assessment techniques

2016 ◽  
Vol 42 (5) ◽  
pp. S25
Author(s):  
Edward St John ◽  
Rashed Al-Khudairi ◽  
Hutan Ashrafian ◽  
Thanos Athanasiou ◽  
Zoltan Takats ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Margin Assessment ◽  
Assessment Techniques ◽  
Intraoperative Margin Assessment

scholarly journals Current Intraoperative Imaging Techniques to Improve Surgical Resection of Laryngeal Cancer: A Systematic Review

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1895
Author(s):  
Lorraine J. Lauwerends ◽  
Hidde A. Galema ◽  
José A. U. Hardillo ◽  
Aniel Sewnaik ◽  
Dominiek Monserez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Optical Imaging ◽  
Surgical Resection ◽  
Laryngeal Cancer ◽  
Narrow Band Imaging ◽  
Imaging Techniques ◽  
Intraoperative Imaging ◽  
Survival Rates ◽  
Margin Assessment ◽  
Recurrence Rates

Laryngeal cancer is a prevalent head and neck malignancy, with poor prognosis and low survival rates for patients with advanced disease. Treatment consists of unimodal therapy through surgery or radiotherapy in early staged tumors, while advanced stage tumors are generally treated with multimodal chemoradiotherapy or (total) laryngectomy followed by radiotherapy. Still, the recurrence rate for advanced laryngeal cancer is between 25 and 50%. In order to improve surgical resection of laryngeal cancer and reduce local recurrence rates, various intraoperative optical imaging techniques have been investigated. In this systematic review, we identify these technologies, evaluating the current state and future directions of optical imaging for this indication. Narrow-band imaging (NBI) and autofluorescence (AF) are established tools for early detection of laryngeal cancer. Nonetheless, their intraoperative utility is limited by an intrinsic inability to image beyond the (sub-)mucosa. Likewise, contact endoscopy (CE) and optical coherence tomography (OCT) are technically cumbersome and only useful for mucosal margin assessment. Research on fluorescence imaging (FLI) for this application is sparse, dealing solely with nonspecific fluorescent agents. Evidently, the imaging modalities that have been investigated thus far are generally unsuitable for deep margin assessment. We discuss two optical imaging techniques that can overcome these limitations and suggest how they can be used to achieve adequate margins in laryngeal cancer at all stages.

scholarly journals Accuracy of frozen section in intraoperative margin assessment for breast-conserving surgery: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248768
Author(s):  
Mila Trementosa Garcia ◽  
Bruna Salani Mota ◽  
Natalia Cardoso ◽  
Ana Luiza Cabrera Martimbianco ◽  
Marcos Desidério Ricci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Frozen Section ◽  
Meta Analysis ◽  
Survival Rates ◽  
Breast Conserving Surgery ◽  
Margin Assessment ◽  
Funnel Plot ◽  
Intraoperative Margin Assessment ◽  
Reoperation Rates

Background and objectives It is well established that tumor-free margin is an important factor for reducing local recurrence and reoperation rates. This systematic review with meta-analysis of frozen section intraoperative margin assessment aims to evaluate the accuracy, and reoperation and survival rates, and to establish its importance in breast-conserving surgery. Methods A thorough review was conducted in all online publication-databases for the related literature up to March 2020. MeSH terms used: “Breast Cancer”, “Segmental Mastectomy” and “Frozen Section”. We included the studies that evaluated accuracy of frozen section, reoperation and survival rates. To ensure quality of the included articles, the QUADAS-2 tool (adapted) was employed. The assessment of publication bias by graphical and statistical methods was performed using the funnel plot and the Egger’s test. The review protocol was registered in PROSPERO (CRD42019125682). Results Nineteen studies were deemed suitable, with a total of 6,769 cases. The reoperation rate on average was 5.9%. Sensitivity was 0.81, with a Confidence Interval of 0.79–0.83, p = 0.0000, I2 = 95.1%, and specificity was 0.97, with a Confidence Interval of 0.97–0.98, p = 0.0000, I-2 = 90.8%, for 17 studies and 5,615 cases. Accuracy was 0.98. Twelve studies described local recurrence and the highest cumulative recurrence rate in 3 years was 7.5%. The quality of the included studies based on the QUADAS-2 tool showed a low risk of bias. There is no publication bias (p = 0.32) and the funnel plot showed symmetry. Conclusion Frozen section is a reliable procedure with high accuracy, sensitivity and specificity in intraoperative margin assessment of breast-conserving surgery. Therefore, this modality of margin assessment could be useful in reducing reoperation rates.

scholarly journals OBTAINING ADEQUATE SURGICAL MARGIN STATUS IN BREAST-CONSERVATION THERAPY: INTRAOPERATIVE ULTRASOUND-GUIDED RESECTION VERSUS SPECIMEN MAMMOGRAPHY

2018 ◽  
Vol 91 (2) ◽  
pp. 197-202
Author(s):  
Maria Mihaela Pop ◽  
Silviu Cristian ◽  
Orsolya Hanko-Bauer ◽  
Dana Valentina Ghiga ◽  
Rares Georgescu
Keyword(s):  
Sensitivity And Specificity ◽  
Breast Conservation ◽  
Intraoperative Ultrasound ◽  
Positive Margin ◽  
Margin Status ◽  
Resected Specimen ◽  
Margin Assessment ◽  
Positive Margins ◽  
Positive Correlation ◽  
Intraoperative Margin Assessment

Background and aim. The purpose of breast-conserving surgery (BCS) for women with cancer is to perform an oncological radical procedure with disease-free margins at the final histological assessment and with the best aesthetic result possible. Intraoperative resected specimen ultrasound and intraoperative resected specimen mammography may reduce the rates of positive margins and reexcision among patients undergoing conserving therapy. Our objective is to compare the two methods with the histopathological  results for a preset cut off and asses which parameters can influence the positive margin status.Method. A prospective study was performed on 83 patients who underwent breast conservation surgery for early breast cancer (pT1-3a pN0-1 M0) between 2014 and 2016. After excision the specimen was oriented in the operating room by the surgeon. Metallic clips and threads were placed on margins: one clip and the long thread at 12 o'clock, two clips and the short threads at 9 o'clock. The next step was intraoperative ultrasound assessment of the specimen. For the margins under 2 mm we performed selective margin shaving, followed by mammography to identify and document the lesion and finally histopathological examination of the specimen with reporting the gross and microscopic margins. The positive margins required re-excision or boost of radiation at the posterior or anterior margins, depending on the case.Results. We set a cut-off at 2 mm. The sensitivity and specificity of the intraoperative margin assessment via the ultrasound method were 90.91% (95% CI 70.84-98.88%) and 67.21% (95% CI 54-78.69%) respectively. The sensitivity and specificity of the intraoperative margin assessment via the mammographic procedure were 45.45% (95% CI 24.39-67.79%) and 85.25% (95% CI 73.83-93.02%) respectively. There was positive correlation between the histopathological and intraoperative ultrasound exam (p=0.018) and negative correlation between the histopathological exam and the post-operative mammographic exam (p=0.68). We found a positive correlation between the positive margin status and age (<40), preoperative chemotherapy, intraductal carcinoma, inflammatory process around the tumor, and the immunohistochemical triple negative profile.Conclusions. According to our results, the intraoperative ultrasound of the breast specimen for a cutt-off at 2 mm can decrease the rates of margin positivity compared to the mammographic procedure and has the potential to diminish the number of subsequent undesired re-excisions.

scholarly journals Comparison of Amino Acid PET to Advanced and Emerging MRI Techniques for Neurooncology Imaging: A Systematic Review of the Recent Studies

2021 ◽  
Vol 2021 ◽  
pp. 1-19
Author(s):  
Brittany M. Stopa ◽  
Csaba Juhász ◽  
Sandeep Mittal
Keyword(s):  
Systematic Review ◽  
Amino Acid ◽  
Brain Tumors ◽  
Tumor Imaging ◽  
Imaging Techniques ◽  
Diagnostic Potential ◽  
Cest Imaging ◽  
Pubmed Search ◽  
Amino Acid Pet ◽  
Improved Performance

Introduction. Standard neuroimaging protocols for brain tumors have well-known limitations. The clinical use of additional modalities including amino acid PET (aaPET) and advanced MRI (aMRI) techniques (including DWI, PWI, and MRS) is emerging in response to the need for more accurate detection of brain tumors. In this systematic review of the past 2 years of the literature, we discuss the most recent studies that directly compare or combine aaPET and aMRI for brain tumor imaging. Methods. A PubMed search was conducted for human studies incorporating both aaPET and aMRI and published between July 2018 and August 2020. Results. A total of 22 studies were found in the study period. Recent studies of aaPET with DWI showed a superiority of MET, FET, FDOPA, and AMT PET for detecting tumor, predicting recurrence, diagnosing progression, and predicting survival. Combining modalities further improved performance. Comparisons of aaPET with PWI showed mixed results about spatial correlation. However, both modalities were able to detect high-grade tumors, identify tumor recurrence, differentiate recurrence from treatment effects, and predict survival. aaPET performed better on these measures than PWI, but when combined, they had the strongest results. Studies of aaPET with MRS demonstrated that both modalities have diagnostic potential but MET PET and FDOPA PET performed better than MRS. MRS suffered from some data quality issues that limited analysis in two studies, and, in one study that combined modalities, overall performance actually decreased. Four recent studies compared aaPET with emerging MRI approaches (such as CEST imaging, MR fingerprinting, and SISTINA), but the initial results remain inconclusive. Conclusions. aaPET outperformed the aMRI imaging techniques in most recent studies. DWI and PWI added meaningful complementary data, and the combination of aaPET with aMRI yielded the best results in most studies.

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