Journal articles on the topic 'Surgical margin delineation'
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Debacker, Jens M., Vanessa Schelfhout, Lieve Brochez, David Creytens, Yves D’Asseler, Philippe Deron, Vincent Keereman, Koen Van de Vijver, Christian Vanhove, and Wouter Huvenne. "High-Resolution 18F-FDG PET/CT for Assessing Three-Dimensional Intraoperative Margins Status in Malignancies of the Head and Neck, a Proof-of-Concept." Journal of Clinical Medicine 10, no. 16 (August 22, 2021): 3737. http://dx.doi.org/10.3390/jcm10163737.
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The surgical treatment of head and neck malignancies relies on the complete removal of tumoral tissue, while inadequate margins necessitate the use of adjuvant therapy. However, most positive margins are identified postoperatively as deep margins, and intraoperative identification of the deep positive margins could help achieve adequate surgical margins and decrease adjuvant therapies. To improve deep-margin identification, we investigated whether the use of high-resolution preclinical PET and CT could increase certainty about the surgical margins in three dimensions. Patients with a malignancy of the head and neck planned for surgical resection were administered a clinical activity of 4MBq/kg 18F-FDG approximately one hour prior to surgical initiation. Subsequently, the resected specimen was scanned with a micro-PET-CT imaging device, followed by histopathological assessment. Eight patients were included in the study and intraoperative PET/CT-imaging of 11 tumoral specimens and lymph nodes of three patients was performed. As a result of the increased resolution, differentiation between inflamed and dysplastic tissue versus malignant tissue was complicated in malignancies with increased peritumoral inflammation. The current technique allowed the three-dimensional delineation of 18F-FDG using submillimetric PET/CT imaging. While further optimization and patient stratification is required, clinical implementation could enable deep margin assessment in head and neck resection specimens.
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Nagahama, Takashi, Kenshi Yao, Noriya Uedo, Hisashi Doyama, Tetsuya Ueo, Kunihisa Uchita, Hideki Ishikawa, et al. "Delineation of the extent of early gastric cancer by magnifying narrow-band imaging and chromoendoscopy: a multicenter randomized controlled trial." Endoscopy 50, no. 06 (February 13, 2018): 566–76. http://dx.doi.org/10.1055/s-0044-100790.
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Abstract Background Accurate delineation of tumor margins is necessary for curative resection of early gastric cancer (EGC). The objective of this multicenter, randomized, controlled study was to compare the accuracy with which magnifying narrow-band imaging (M-NBI) and indigo carmine chromoendoscopy delineate EGC margins. Methods Patients with EGC ≥ 10 mm undergoing endoscopic or surgical resection were enrolled. The oral-side margins of the lesions were first evaluated with conventional white-light endoscopy in both groups and then delineated by either chromoendoscopy or M-NBI. Biopsies were taken from noncancerous and cancerous mucosa, each at 5 mm from the margin. Accurate delineation was judged to have been achieved when the histological findings in all biopsy samples were consistent with endoscopic diagnoses. The primary end point was the difference in rate of accurate delineation between the two techniques. Results Data on 343 patients were analyzed. The accurate delineation rate (95 % confidence interval) was 85.7 % (80.4 – 91.0) in the chromoendoscopy group (n = 168), and 88.0 % (83.2 – 92.8) in the M-NBI group (n = 175; P = 0.63). Lower third tumor location (odds ratio [OR] 2.9; P = 0.01), nonflat macroscopic type (OR 4.4; P < 0.01), and high diagnostic confidence (OR 3.6; P < 0.001) were associated with accurate delineation, whereas use of M-NBI was not (OR 1.2; P = 0.39). Even after adjustment for identified confounders, the difference in accurate delineation between the groups was not significant (OR 1.0; P = 0.82). Conclusions M-NBI does not offer superior delineation of EGC margins compared with chromoendoscopy; the two methods appear to be clinically equivalent.
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Dika, Emi, Pier Alessandro Fanti, Alma Ismaili, Cosimo Misciali, Sabina Vaccari, Alessia Barisani, and Annalisa Patrizi. "Basal cell carcinoma margin delineation: is curettage useful? A surgical and histological study." Journal of Dermatological Treatment 24, no. 3 (February 24, 2013): 238–42. http://dx.doi.org/10.3109/09546634.2012.756572.
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DOUPLIK, ALEXANDRE, AZHAR ZAM, RALPH HOHENSTEIN, ANGELOS KALITZEOS, EMEKA NKENKE, and FLORIAN STELZLE. "LIMITATIONS OF CANCER MARGIN DELINEATION BY MEANS OF AUTOFLUORESCENCE IMAGING UNDER CONDITIONS OF LASER SURGERY." Journal of Innovative Optical Health Sciences 03, no. 01 (January 2010): 45–51. http://dx.doi.org/10.1142/s179354581000085x.
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Limitations of cancer margin delineation and surgical guidance by means of autofluorescence imaging under conditions of laser ablation were investigated and preliminary results are presented. PinPoint™ (Novadaq Technologies Inc., Canada) was used to capture digital images and Er:YAG laser (2.94 μm, Glissando, WaveLight™, Germany) was exploited to cause laser ablation on both normal and cancer sites of the specimen. It was shown that changes of the autofluorescence image after ablation extend beyond the actual sizes of the ablation loci. The tumor tissue after the laser ablation starts to emit fluorescent light within the green wavelength band (490–550 nm) similar to normal tissue stating that the current technology of in-process tissue classification fails. However, when the autofluorescence was collected in the red range (600–750 nm), then the abnormal/normal contrast was reduced, but still present even after the laser ablation. The present study highlights the importance of finding a proper technology for surgical navigation of cancer removal under conditions of high power effects in biological tissues.
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Edwards, Steven J., Ifigeneia Mavranezouli, George Osei-Assibey, Gemma Marceniuk, Victoria Wakefield, and Charlotta Karner. "VivaScope® 1500 and 3000 systems for detecting and monitoring skin lesions: a systematic review and economic evaluation." Health Technology Assessment 20, no. 58 (July 2016): 1–260. http://dx.doi.org/10.3310/hta20580.
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BackgroundSkin cancer is one of the most common cancers in the UK. The main risk factor is exposure to ultraviolet radiation from sunlight or the use of sunbeds. Patients with suspicious skin lesions are first examined with a dermoscope. After examination, those with non-cancerous lesions are discharged, but lesions that are still considered clinically suspicious are surgically removed. VivaScope®is a non-invasive technology designed to be used in conjunction with dermoscopy to provide a more accurate diagnosis, leading to fewer biopsies of benign lesions or to provide more accurate presurgical margins reducing the risk of cancer recurrence.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of VivaScope®1500 (Caliber Imaging and Diagnostics, Rochester, NY, USA; Lucid Inc., Rochester, NY, USA; or Lucid Inc., MAVIG GmbH, Munich, Germany) and VivaScope®3000 (Caliber Imaging and Diagnostics, Rochester, NY, USA) in the diagnosis of equivocal skin lesions, and VivaScope 3000 in lesion margin delineation prior to surgical excision of lesions.Data sourcesDatabases (MEDLINE, EMBASE and The Cochrane Library) were searched on 14 October 2014, reference lists of included papers were assessed and clinical experts were contacted for additional information on published and unpublished studies.MethodsA systematic review was carried out to identify randomised controlled trials (RCTs) or observational studies evaluating dermoscopy plus VivaScope, or VivaScope alone, with histopathology as the reference test. A probabilistic de novo economic model was developed to synthesise the available data on costs and clinical outcomes from the UK NHS perspective. All costs were expressed as 2014 prices.ResultsSixteen studies were included in the review, but they were too heterogeneous to be combined in a meta-analysis. One of two diagnostic studies that were deemed most representative of UK clinical practice reported that dermoscopy plus VivaScope 1500 was significantly more sensitive than dermoscopy alone in the diagnosis of melanoma (97.8% vs. 94.6%;p = 0.043) and significantly more specific than dermoscopy alone in the diagnosis of non-melanoma (92.4% vs. 26.74%;p < 0.000001). The results of another study suggest 100% [95% confidence interval (CI) 86.16% to 100%] sensitivity for dermoscopy plus VivaScope 1500 versus 100% (95% CI 91.51% to 100%) for dermoscopy alone. Specificity varied from 51.77% to 80.2% depending on the analysis set used. In terms of margin delineation with VivaScope, one study found that 17 out of 29 patients with visible lentigo maligna (LM) had subclinical disease of > 5 mm beyond the dermoscopically identified margin. Using ‘optimistic’ diagnostic data, the economic model resulted in an incremental cost-effectiveness ratio (ICER) of £8877 per quality-adjusted life-year (QALY) (£9362 per QALY), while the ‘less favourable’ diagnostic data resulted in an ICER of £19,095 per QALY (£25,453 per QALY) in the diagnosis of suspected melanomas. VivaScope was also shown to be a dominant strategy when used for the diagnostic assessment of suspected basal cell carcinoma (BCC). Regarding margin delineation of LM, mapping with VivaScope was cost-effective, with an ICER of £10,241 per QALY (£11,651 per QALY). However, when VivaScope was used for diagnosis as well as mapping of LM, then the intervention cost was reduced and VivaScope became a dominant strategy.LimitationsThere is an absence of UK data in the included studies and, therefore, generalisability of the results to the UK population is unclear.ConclusionsThe use of VivaScope appears to be a cost-effective strategy in the diagnostic assessment of equivocal melanomas and BCCs, and in margin delineation of LM prior to surgical treatment.Future workHigh-quality RCTs are required in a UK population to assess the diagnostic accuracy of VivaScope in people with equivocal lesions.Study registrationThis study is registered as PROSPERO CRD42014014433.FundingThe National Institute for Health Research Health Technology Assessment programme.
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Makouei, Fatemeh, Caroline Ewertsen, Tina Klitmøller Agander, Mikkel Vestergaard Olesen, Bente Pakkenberg, and Tobias Todsen. "3D Ultrasound versus Computed Tomography for Tumor Volume Measurement Compared to Gross Pathology—A Pilot Study on an Animal Model." Journal of Imaging 8, no. 12 (December 19, 2022): 329. http://dx.doi.org/10.3390/jimaging8120329.
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The margin of the removed tumor in cancer surgery has an important influence on survival. Adjuvant treatments, prognostic complications, and financial costs are required when the pathologist observes a close/positive surgical margin. Ex vivo imaging of resected cancer tissue has been suggested for margin assessment, but traditional cross-sectional imaging is not optimal in a surgical setting. Instead, three-dimensional (3D) ultrasound is a portable, high-resolution, and low-cost method to use in the operation room. In this study, we aimed to investigate the accuracy of 3D ultrasound versus computed tomography (CT) to measure the tumor volume in an animal model compared to gross pathology assessment. The specimen was formalin fixated before systematic slicing. A slice-by-slice area measurement was performed to compare the accuracy of the 3D ultrasound and CT techniques. The tumor volume measured by pathological assessment was 980.2 mm3. The measured volume using CT was 890.4 ± 90 mm3, and the volume using 3D ultrasound was 924.2 ± 96 mm3. The correlation coefficient for CT was 0.91 and that for 3D ultrasound was 0.96. Three-dimensional ultrasound is a feasible and accurate modality to measure the tumor volume in an animal model. The accuracy of tumor delineation on CT depends on the soft tissue contrast.
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El Shafie, Rami, Eric Tonndorf-Martini, Daniela Schmitt, Dorothea Weber, Aylin Celik, Thorsten Dresel, Denise Bernhardt, et al. "Pre-Operative Versus Post-Operative Radiosurgery of Brain Metastases—Volumetric and Dosimetric Impact of Treatment Sequence and Margin Concept." Cancers 11, no. 3 (March 1, 2019): 294. http://dx.doi.org/10.3390/cancers11030294.
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Background: Pre-operative radiosurgery (SRS) preceding the resection of brain metastases promises to circumvent limitations of post-operative cavity SRS. It minimizes uncertainties regarding delineation and safety margins and could reduce dose exposure of the healthy brain (HB). Methods: We performed a systematic treatment plan comparison on 24 patients who received post-operative radiosurgery of the resection cavity at our institution. Comparative treatment plans were calculated for hypofractionated stereotactic radiotherapy (7 × 5 Gray (Gy)) in a hypothetical pre-operative (pre-op) and two post-operative scenarios, either with (extended field, post-op-E) or without the surgical tract (involved field, post-op-I). Detailed volumetric comparison of the resulting target volumes was performed, as well as dosimetric comparison focusing on targets and the HB. Results: The resection cavity was significantly smaller and different in morphology from the pre-operative lesion, yielding a low Dice Similarity Coefficient (DSC) of 53% (p = 0.019). Post-op-I and post-op-E targets showed high similarity (DSC = 93%), and including the surgical tract moderately enlarged resulting median target size (18.58 ccm vs. 22.89 ccm, p < 0.001). Dosimetric analysis favored the pre-operative treatment setting since it significantly decreased relevant dose exposure of the HB (Median volume receiving 28 Gy: 6.79 vs. 10.79 for pre-op vs. post-op-E, p < 0.001). Dosimetrically, pre-operative SRS is a promising alternative to post-operative cavity irradiation that could furthermore offer practical benefits regarding delineation and treatment planning. Comparative trials are required to evaluate potential clinical advantages of this approach.
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Onoe, Shunsuke, Yoshie Shimoyama, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Gen Sugawara, Shigeo Nakamura, and Masato Nagino. "Prognostic delineation of papillary cholangiocarcinoma based on the invasive proportion." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 4119. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.4119.
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4119 Background: Intraductal papillary neoplasm of the bile duct (IPNB) is a presumed precursor lesion in biliary carcinogenesis, clinicopathologically overlapping with papillary cholangiocarcinoma (PCC); however, as IPNB has no standardized definition, this relationship remains equivocal. Here, we aimed to develop a new PCC prognostic model, focusing on the invasive proportion. Methods: Among 605 patients with surgically resected cholangiocarcinoma in Nagoya University Hospital between 2000 and 2011, 173 (29%) had intraductal exophytic papillary lesions. These were divided into four subsets based on the invasive component: non-invasive (PCC-1, n = 13), ≤10% (PCC-2, n = 30), 11-50% (PCC-3, n = 55), and >50% (PCC-4, n = 75). Results: Invasion beyond the ductal wall was observed in 83% of PCCs and 99% of non-papillary cholangiocarcinomas (NPCC, n = 432; P < 0.001). Regional lymph node metastases were more frequent in NPCC (48%) than PCC (32%; P < 0.001). Five-year survival was better for PCC (52%) than NPCC (37%; P < 0.001), indicating the papillary component to be a significant independent prognosticator. PCC-4 and NPCC had similar clinicopathological features and overlapping survival curves: 32% and 37% at 5 years (P = 0.877), both lower than those of PCC-1, PCC-2, and PCC-3 (respectively, 91%, 71%, and 60% at 5 years; P < 0.01 in all combinations). Multivariate analysis in PCC showed >50% invasive component, nodal metastasis, and positive surgical margin as independent predictors. Conclusions: The presence of an intraductal papillary component was an important determinant of better survival in cholangiocarcinoma. PCC exhibited a more aggressive histologic character and worse survival with progression of the invasive component. PCC with >50% invasive component was morphologically and prognostically similar to NPCC. Therefore, we propose that IPNB should be nosologically applied only for PCC cases with ≤50% invasive component.
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Whitson, Wesley J., Pablo A. Valdes, Brent T. Harris, Keith D. Paulsen, and David W. Roberts. "Confocal Microscopy for the Histological Fluorescence Pattern of a Recurrent Atypical Meningioma: Case Report." Neurosurgery 68, no. 6 (June 1, 2011): E1768—E1773. http://dx.doi.org/10.1227/neu.0b013e318217163c.
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Abstract BACKGROUND AND IMPORTANCE: Fluorescence-guided resection with 5-aminolevulinic acid (5-ALA), which has shown promising results in the resection of malignant gliomas, has been used for meningioma resection in an attempt to more clearly delineate the tumor margin. However, no article has investigated the fluorescence pattern of meningiomas on a histological level. Understanding the microscopic pattern of fluorescence could help assess the precision and utility of using 5-ALA for these tumors. We present the case of a recurrent atypical meningioma operated on with 5-ALA fluorescence-guided resection for delineation of tumor tissue from surrounding uninvolved dura. CLINICAL PRESENTATION: A 53-year-old woman presented with recurrent atypical meningioma of the falx. Prior treatment included surgical resection 6 years earlier with subsequent fractionated radiation therapy and radiosurgery for tumor progression. The patient was given 5-ALA 20 mg/kg body weight dissolved in 100 mL water 3 hours before induction of anesthesia. Intraoperative fluorescence was coregistered with preoperative imaging. Neuropathological analysis of the resected falx with confocal microscopy enabled correlation of fluorescence with the extent of tumor on a histological level. CONCLUSION: Fluorescence guidance allowed clear intraoperative delineation of tumor tissue from adjacent, uninvolved dura. On a microscopic level, there was a very close correlation of fluorescence with tumor, but some tumor cells did not fluoresce.
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Halip, Ioana-Alina, Dan Vâţă, Laura Statescu, Paul Salahoru, Adriana Ionela Patraşcu, Doinita Temelie Olinici, Bogdan Tarcau, et al. "Assessment of Basal Cell Carcinoma Using Dermoscopy and High Frequency Ultrasound Examination." Diagnostics 12, no. 3 (March 18, 2022): 735. http://dx.doi.org/10.3390/diagnostics12030735.
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Basal cell carcinoma (BCC) is the most common form of cutaneous neoplasia in humans, and dermoscopy may provide valuable information for histopathological classification of BCC, which allows for the choice of non-invasive topical or surgical therapy. Similarly, dermoscopy may allow for the identification of incipient forms of BCC that cannot be detected in clinical examination. The importance of early diagnosis using the dermoscopy of superficial BCC forms is proven by the fact that despite their indolent clinical appearance, they can be included in high-risk BCC forms due to the rate of postoperative recurrence. Nodular pigmentary forms of BCCs present ovoid gray-blue nests or multiple gray-blue dots/globules associated with arborized vessels, sometimes undetectable on clinical examination. The management of BCC depends on this, as pigmentary forms have been shown to have a poor response to photodynamic therapy. High frequency ultrasound examination (HFUS) aids in the diagnosis of BCC with hypoechoic tumour masses, as well as in estimating tumour size (thickness and diameter), presurgical margin delineation, and surgical planning. The examination is also useful for determining the invasion of adjacent structures and for studying local recurrences. The use of dermoscopy in combination with HFUS allows for optimisation of the management of the oncological patient.
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Cannatà, M., R. Russo, F. Beghella Bartoli, I. Palumbo, H. Tran, C. Votta, M. Lupattelli, et al. "P02.11.B An hypothesis generating study of MRI-Derived Radiomics on tumor and microenvironment tissue heterogeneity to guide post-operative management of glioblastoma: toward personalized radiation treatment volume delineation." Neuro-Oncology 24, Supplement_2 (September 1, 2022): ii31—ii32. http://dx.doi.org/10.1093/neuonc/noac174.104.
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Abstract Background The glioblastoma’s bad prognosis is primarily due to intra-tumor heterogeneity, demonstrated from several studies that collected molecular biology, cytogenetic data and more recently radiomic features for a better prognostic stratification.The GLIFA project (GLIoblastoma Feature Analysis) is a multicentric project planned to investigated the role of radiomic analysis in GBM management, to verify if radiomic features in the tissue around the resection cavity which may guide the radiation target volume delineation. Material and Methods We retrospectively analyze from three centers radiomic features extracted from 90 patients with total or near total resection, who completed the standard adjuvant treatment and for whom we had post-operative images available for features extraction.The Manual segmentation was performed on post gadolinium T1w MRI sequence by 2 radiation oncologist reviewed by a neuroradiologist, both with at least 10 years of experience. The Region of interest (ROI) considered for the analysis were: the surgical cavity +/- post-surgical residual mass (CTV_cavity); the CTV a margin of 1.5 cm added to CTV_cavity and the volume resulting from subtracting the CTV_cavity from the CTV was defined as CTV_Ring. Radiomic analysis and modelling were conducted in RStudio. Z-score normalization was applied to each radiomic feature. A radiomic model was generated using the 226 features extracted from the Ring to perform a binary classification and predict the PFS at 6 months (statistical, morphological and textural features). A 3-fold cross-validation repeated five times was implemented for internal validation of the model. Results Two-hundred and seventy ROIs were contoured. The proposed radiomic model was given by the best fitting logistic regression model, and included the following 3 features: F_cm_merged.contrast, F_cm_merged.info.corr.2, F_rlm_merged.rlnu. A good agreement between model predicted probabilities and observed outcome probabilities was obtained (p-value of 0.49 by Hosmer and Lemeshow statistical test). The ROC curve of the model reported an AUC of 0.78 (95% CI: 0.68 - 0.88). Conclusion This is the first hypothesis-generating study who applies a radiomic analysis focusing on healthy tissue ring around the surgical cavity on post-operative MRI. This study provides a preliminary model for a decision support tool for a customization of the radiation target volume in GBM patients in order to achieve a margin reduction strategy.
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King, Mary E., Jialing Zhang, John Q. Lin, Kyana Y. Garza, Rachel J. DeHoog, Clara L. Feider, Alena Bensussan, et al. "Rapid diagnosis and tumor margin assessment during pancreatic cancer surgery with the MasSpec Pen technology." Proceedings of the National Academy of Sciences 118, no. 28 (July 6, 2021): e2104411118. http://dx.doi.org/10.1073/pnas.2104411118.
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Intraoperative delineation of tumor margins is critical for effective pancreatic cancer surgery. Yet, intraoperative frozen section analysis of tumor margins is a time-consuming and often challenging procedure that can yield confounding results due to histologic heterogeneity and tissue-processing artifacts. We have previously described the development of the MasSpec Pen technology as a handheld mass spectrometry–based device for nondestructive tissue analysis. Here, we evaluated the usefulness of the MasSpec Pen for intraoperative diagnosis of pancreatic ductal adenocarcinoma based on alterations in the metabolite and lipid profiles in in vivo and ex vivo tissues. We used the MasSpec Pen to analyze 157 banked human tissues, including pancreatic ductal adenocarcinoma, pancreatic, and bile duct tissues. Classification models generated from the molecular data yielded an overall agreement with pathology of 91.5%, sensitivity of 95.5%, and specificity of 89.7% for discriminating normal pancreas from cancer. We built a second classifier to distinguish bile duct from pancreatic cancer, achieving an overall accuracy of 95%, sensitivity of 92%, and specificity of 100%. We then translated the MasSpec Pen to the operative room and predicted on in vivo and ex vivo data acquired during 18 pancreatic surgeries, achieving 93.8% overall agreement with final postoperative pathology reports. Notably, when integrating banked tissue data with intraoperative data, an improved agreement of 100% was achieved. The result obtained demonstrate that the MasSpec Pen provides high predictive performance for tissue diagnosis and compatibility for intraoperative use, suggesting that the technology may be useful to guide surgical decision-making during pancreatic cancer surgeries.
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Zhao, Fen, Minghuan Li, Zheng Fu, and Jinming Yu. "3'-deoxy-3'-[18F]fluorothymidine position emission tomography for target delineation in resected malignant gliomas before radiotherapy." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e13052-e13052. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e13052.
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e13052 Background: To analyze the FLT PET image feature of malignant gliomas and evaluate the usefulness in the visualization of residual tumor volume compared with MRI. Methods: Patients with postoperative residual malignant gliomas were enrolled on this prospective trial. MRI and PET were performed in the same week, 1 to 4 weeks after surgical resection.,we compared the SUVmax of tumor and the T/N ratio between the grade III and IV gliomas and the residual tumor volume and the geometric position defined by FLT uptake and the abnormalities signals on MRI were compared using FLT PET/MRI fusion images. Results: 19 patients were analyzed. The SUVmax were 0.86±28 for grade 3 gliomas , and 2.68±2.22 or 2.05±0.44(with or without one gliosarcoma whose SUVmax was as high as 9.6) for grade IV gliomas (P <0.001). The mean (±SD) value of T/N ratio in grade IV gliomas were 15.43±10.47 or 12.48±2.20(including or not of the gliosarcoma ) and 4.84±1.77 in gade III gliomas(P <0.001). The mean Vol-T1, Vol-T2 and Vol-PET was 13.08cm3,33.46cm3 , and 15.04cm3 , respectively. The Vol-PET were not significant larger than the Vol-T1( P>0.05). The areas between the increased FLT PET activity and abnormality in MRI were imperfectly correlated .In 13 (68.4%) and 11 patients(57.90%) , the FLT uptake regions exceeded the area of contrast enhancement and the area of hyperintensity areas on the MRI. In 5 (26.3%) and 4(21.05%) of 19 patients, FLT uptake extended 25 mm from the margin of Gd enhancement and hyperintensity areas. And the FLT uptake was measured up to 43mm and 39mm outside of the Gd enhancement and hyperintensity areas on MRI. Conclusions: FLT PET was found to be useful in assessment of grade in malignant gliomas. FLT PET can provide complement information to the MRI for defining the remaining tumor volume accurately in patients with malignant gliomas postoperative residual .
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Pirotte, Benoit, Serge Goldman, Patrick Van Bogaert, Philippe David, David Wikler, Sandrine Rorive, Jacques Brotchi, and Marc Levivier. "Integration of [11C]Methionine-Positron Emission Tomographic and Magnetic Resonance Imaging for Image-guided Surgical Resection of Infiltrative Low-grade Brain Tumors in Children." Operative Neurosurgery 57, suppl_1 (July 1, 2005): 128–39. http://dx.doi.org/10.1227/01.neu.0000163598.59870.6d.
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Abstract OBJECTIVE: To evaluate the interest of integrating positron emission tomography (PET) images with the radiolabeled tracer [11C]methionine (Met) into the image-guided navigation planning of infiltrative low-grade brain tumors (LGBTs) in children. METHODS: Twenty-two children underwent combined Met-PET with magnetic resonance imaging (MRI) scans in the planning of a navigation procedure. These children presented an LGBT (astrocytomas, 10; oligodendrogliomas, 4; ependymomas, 4; gangliogliomas, 4) located close to functional areas. Tumor boundaries were ill-defined on MRI (including T2-weighted and fluid-attenuated inversion-recovery scans) and could not be clearly identified for allowing a complete, or at least a large, image-guided resection. The PET tracer Met was chosen because of its higher sensitivity and specificity than MRI to detect tumor tissue. The level and extension of MET uptake were analyzed to define the PET contour, subsequently projected onto MRI scans to define a final target contour for volumetric resection. The quality of tumor resection was assessed by an early postoperative MRI and Met-PET workup. RESULTS: In 20 of the 22 children with ill-defined LGBTs, PET improved tumor delineation and contributed to define a final target contour different from that obtained with MRI alone. Met-PET guidance allowed a total resection of Met uptake in 17 cases that were considered total tumor resections because the operative margin left in place contained nontumor tissue. CONCLUSION: These data suggested that Met-PET guidance could help to improve the number of total resections and the amount of tumor removed in infiltrative LGBTs in children.
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Mousli, A., B. Bihin, T. Gustin, G. Koerts, M. Mouchamps, and J. F. Daisne. "P03.02 Risk of leptomeningeal dissemination in patients treated with postoperative stereotactic radiotherapy of brain metastases." Neuro-Oncology 21, Supplement_3 (August 2019): iii24—iii25. http://dx.doi.org/10.1093/neuonc/noz126.083.
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Abstract Background There is a body of evidence that the risk of leptomeningeal dissemination (LMD) is increased in the postoperative stereotactic radiotherapy (SRT) of brain metastases (BM) compared to adjuvant whole brain radiotherapy (WBRT). The proposed mechanism is an iatrogenic tumor dissemination into the cerebrospinal fluid at time of surgery. Including a wider volume of meningeal wall and the entire surgical track in the definition of the postoperative SRT clinical target volume (CTV) to decrease LMD is still controversial. The aim of this study was to retrospectively analyze the outcome of adjuvant SRT targeted at resection cavities of BM without previous WBRT. MATERIAL / METHODS We reviewed 70 patients treated with postoperative SRT for BM. Stereotactic planning computed tomography and planning MRI were imported into iPlan RT image software for image registration and TV delineation. The CTV consisted of any residual enhancement and all resected cavity including a safety margin of 1 to 2 mm. Only in cases of superficial initial tumor with meningeal contact was the CTV enlarged to the adjacent meningeal wall, but never included edema or the entire surgical track. Patients underwent regular follow-up MRI. The cumulative incidence rates of LMD was retrospectively calculated as well as patterns of failure. RESULTS The most common histological type was non small cell lung cancer in 61.4%. There were 38.6% infratentorial locations and 37.2 % superficial lesions. En bloc resection was achieved in 60% and compete resection in 75.7%. After a median imaging follow up time of 16.7 months, 54.3% of patients experienced distant brain failure. LMD occurred in 9 of 70 patients (12.9 %) at a median time of 10.7 months. Survival without LMD was 88% at 1 year (IC 95% 79%-97%) and 82% at 2years (IC 95% 72%-94%). In three quarter of cases, LMD interested superficial lesions. In univariate analysis, survival rates without LMD at 1 year for superficial and deep lesions were 88 % and 94 %, respectively (p=0.49). We report only one recurrence in the surgical track (1.42%). CONCLUSION The risk of LMD was comparable to the literature (11–17%). Superficial lesions were slightly more likely to relapse in the meninges, but it was non-significant. The risk of recurrence in the surgical track is negligible. Our results do not support the current guidelines recommending the systematic inclusion of the surgical track and the related meninges in the CTV.
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Cifarelli, Christopher Paul, John Austin Vargo, Joshua Hack, Paul B. Renz, Linda Poplawski, Geraldine M. Jacobson, Klaus Henning Kahl, Stefanie Brehmer, Gustavo Sarria, and Frank Anton Giordano. "Intraoperative radiotherapy (IORT) for surgically resected brain metastases: Local control and dosimetric analysis." Journal of Global Oncology 5, suppl (October 7, 2019): 114. http://dx.doi.org/10.1200/jgo.2019.5.suppl.114.
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114 Background: The optimal use of adjuvant radiation following surgical resection of large brain metastases (BM) remains undetermined. Time to initiation following surgery and target delineation both impact local control (LC). Intraoperative radiotherapy (IORT) allows for elimination of lag time between surgery and radiation, direct cavity targeting, and safe dose escalation beyond traditional stereotactic radiosurgery (SRS). The current study provides an analysis of local disease control and dosimetric parameters related to intracranial IORT. Methods: Retrospective data was collected on patients treated with IORT immediately following surgical resection of BMs at three institutions according to the approval of individual IRBs. All patients were treated with the Zeiss Intrabeam device (Carl Zeiss Meditech, Germany) using spherical applicators ranging from 1.5 to 4.0cm with 50kV output. Statistical analyses were performed using SPSS (IBM) with endpoints of LC and incidence of RN, with p < 0.05 considered significant. Dosimetric comparisons between IORT and SRS were made based on V10, V12, and dose homogeneity based on percent of GTV receiving greater than 20Gy or 30Gy. Results: 54 patients were treated with IORT with a median age of 64 years. The most common primary diagnosis was non-small cell lung cancer (40%) with the most common location in the frontal lobe (38%). Median follow-up was 7.2 months and 1-year LC rate was 88% with radiation necrosis (RN) present in 4 patients (7%). The dosimetric comparison of a single IORT case revealed non-target V10 and V12 volumes as 24.75cm3 and 14.76cm3, respectively, for the SRS treatment plan of 16Gy to the margin. The V10 and V12 for the IORT treatment plan were 20.83cm3 and 9.93cm3 with a surface dose of 30Gy. The volumes exceeding 20Gy and 30Gy in the SRS plan were 14.73cm3 and 0.328cm3, respectively, while the corresponding volumes in the IORT plan were 9.8cm3 and 0cm3. Conclusions: IORT is a safe and effective means of delivering adjuvant radiation to the BM resection cavities with a high rate of LC, low incidence of RN, increased homogeneity of target dose and ability to escalate dose beyond traditional SRS plans.
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Dutour, A., A. Decouveleare, V. Josserand, J. Coll, F. Chotel, and R. Rousseau. "Improving the detection of osteosarcoma tumor margins and metastasis using diagnostic nanoparticles." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 10512. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.10512.
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10512 Background: The aim of osteosarcoma resection is the complete removal of the primary malignant lesion with adequate margins taking into account tumor control and functional reconstruction. To date, no intraoperative method is available to assist surgeons in precisely delineating tumor extension in the adjacent normal tissues. Thus, preoperative imaging and extended surgical resection remains the gold standard. We developed fluorescent nanoparticles RAFT-cRGD4-ICG’ targeting αVβ3 integrins on tumor neovessels and demonstrated their capacity to reveal tumor and its margins when exposed to near infrared (NIR) light. Methods: We evaluated in an orthotopic metastatic osteosarcoma in rats the potential of RAFT-cRGD4-ICG’ detected intra operatively by NIR illumination to improve margin resection without compromising local tumor control. Controls consisted of pathological margin analysis of the resected tumor/metastasis comparing ICG’ fluorescence with conventional tissue coloration, and pre operative magnetic resonance imaging. Results: We showed a significantly lesser extent of healthy tissue resection after surgical excision when assessing tumor margin intra operatively using RAFT-cRGD4-ICG’ and NIR camera compared to preoperative imaging studies and post operative conventional pathology coloration (p<0.01). Importantly, intraoperative NIR illumination of lungs revealed more metastases than by intraoperative manual lung palpation (p<0.01). Conclusions: Our preclinical data confirm the potential of intraoperative imaging for improved primary tumor and lung metastasis excision. We are now generating clinical-grade RAFT-cRGD4-ICG’ to further evaluate this approach as a mean to improve functional outcome after surgical excision while maintaining tumor control in patients with relapsed/metastatic osteosarcoma. No significant financial relationships to disclose.
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dall'Oglio, Stefano, Sergio Maluta, Nadia Marciai, and Milena Gabbani. "Intraoperative electron radiotherapy in early-stage breast cancer: A report on 226 patients." Journal of Clinical Oncology 30, no. 27_suppl (September 20, 2012): 143. http://dx.doi.org/10.1200/jco.2012.30.27_suppl.143.
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143 Background: We report the results of a single-institution phase II trial of accelerated partial breast irradiation (APBI) using a single dose of intraoperative electron radiotherapy (IOERT) in patients with low-risk early-stage breast cancer. Methods: From July 2006 to December 2009, 226 patients suitable for BCT were enrolled in a phase II trial with IOERT as radical treatment immediately after surgical resection. All patients had biopsy-proven cancer. After the surgeon temporarily re-approximated the excision cavity, a dose of 21 Gy using IOERT was delivered to the tumor bed with a margin of 2 cm laterally. Results: No acute reactions were reported after irradiation. Three patients experienced a transient edema. In 7 others a haematoma was observed. No cases of liponecrosis were observed. With a mean follow-up of 49 months (range 31-66 months), only one case of local recurrence has been reported. The observed toxicity was considered acceptable. As to cosmetic results, at 6 months after the end of IORT, 71/226 patients (31.4.%) had a score of 2 for symmetry and contour (asymmetry exhibited by 1/3 or less of volume breast), while 19/226 (8.4%) had a score 3 (asymmetry greater than 1/3 of breast volume). These findings remained unchanged at the following examinations. No breast oedema, discoloration at site or scar prominence were observed. Conclusions: IOERT offers the advantage of an excellent delineation of the tumor bed under visual control and high sparing of normal tissue, including the skin. IOERT delivers a very high biologically dose at the time of the surgery, when residual tumor cells are more rapidly proliferating. IOERT is insensitive to chemotherapy sequencing since all of the radiation is given during the surgery. The absolute recurrence rate of 0.4% and the recurrence rate per year of 0.2% of the present study are very encouraging. APBI using a single dose of IOERT can be delivered safely in women with early, low-risk breast cancer. A longer follow-up is needed to ascertain its efficacy compared to that of the current standard treatment of whole breast irradiation.
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Blakaj, D., J. L. Fox, J. Manzerova, R. Hannan, L. Hong, K. J. Mehta, and S. Kalnicki. "Toxicity of hypofractionated adjuvant radiation after breast-conserving surgery for DCIS." Journal of Clinical Oncology 29, no. 27_suppl (September 20, 2011): 128. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.128.
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128 Background: Traditional fractionation for whole breast radiation therapy after breast-conserving surgery has been 50Gy in 25 fractions over a 5-week period, with or without a 10 Gy boost. Hypofractionation has recently been adapted for early-stage invasive breast cancer, typically treating with 42.5 Gy in 16 daily fractions. This approach has been shown to have equivalent efficacy as the more traditional schedule. Its application to patients with DCIS has been an extrapolation of these data, and warrants further examination. This retrospective analysis reviews toxicity outcomes in women with DCIS treated with hypofractionation at our institution. Methods: 59 women with DCIS treated with lumpectomy and hypofractionated radiotherapy with or without boost between 2006 and 2010 at the Einstein-Montefiore Cancer Center were identified. Median age was 65 (39-85). Median follow-up was 13.7 months (2–37.6). Surgical margin status was negative in 55, positive in 1, and unknown in 3. Thirteen patients had high-grade DCIS, 17 intermediate-grade, and 13 low-grade nuclear features, and 16 did not have grade delineation. 68% of patients (40 women) had disease that was positive both for ER and PR receptors, 2 women were simultaneously positive for ER and PR, 5 women had ER-only positive disease, 2 women had HER2-neu-only positive disease, 1 woman was positive for both ER and HER2-neu receptors, 1 woman was positive only for PR receptors, and 6 women were negative for all receptors; receptor status of specimens from 2 patients is not known. All women were treated with whole-breast hypofractionated therapy (42.4 Gy, in 16 fractions of 2.65 Gy each). 49 women received a boost to the lumpectomy cavity consisting of 10Gy in 5 fractions or 9.6 Gy in 4 fractions at the physician’s discretion. Results: With this regimen, no patient experienced acute RTOG grade 3 or higher skin, or other toxicity. No treatment breaks were required due to toxicity. The most common side effects were grade 1 dermatitis, followed by grade 2 dermatitis with mild edema of the treated breast. Conclusions: Our results suggest that postoperative hypofractionated radiation to the breast is well tolerated by women with DCIS and does not result in untoward acute toxicity.
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OTA, Yoshihide, Kazunari KARAKIDA, Takayuki AOKI, Hiroshi YAMASAKI, Yusuke MORI, Noriko NAKATOGAWA, Mitsunobu OTSURU, Yoshiyuki OSAMURA, and Keiichi TSUKINOKI. "DELINEATION OF SURGICAL MARGINS FOR TONGUE CARCINOMA USING INTRAORAL ULTRASONOGRAPHY." Japanese jornal of Head and Neck Cancer 28, no. 1 (2002): 52–56. http://dx.doi.org/10.5981/jjhnc1974.28.52.
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Sun, Li-Fan, Chen-Xing Wang, Zheng-Yao Cao, Wei Han, Song-Song Guo, Yi-Zhou Wang, Ying Meng, et al. "Evaluation of autofluorescence visualization system in the delineation of oral squamous cell carcinoma surgical margins." Photodiagnosis and Photodynamic Therapy 36 (December 2021): 102487. http://dx.doi.org/10.1016/j.pdpdt.2021.102487.
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Redmond, Kristin J., Simon S. Lo, Scott G. Soltys, Yoshiya Yamada, Igor J. Barani, Paul D. Brown, Eric L. Chang, et al. "Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey." Journal of Neurosurgery: Spine 26, no. 3 (March 2017): 299–306. http://dx.doi.org/10.3171/2016.8.spine16121.
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OBJECTIVE Although postoperative stereotactic body radiation therapy (SBRT) for spinal metastases is increasingly performed, few guidelines exist for this application. The purpose of this study is to develop consensus guidelines to promote safe and effective treatment for patients with spinal metastases. METHODS Fifteen radiation oncologists and 5 neurosurgeons, representing 19 centers in 4 countries and having a collective experience of more than 1300 postoperative spine SBRT cases, completed a 19-question survey about postoperative spine SBRT practice. Responses were defined as follows: 1) consensus: selected by ≥ 75% of respondents; 2) predominant: selected by 50% of respondents or more; and 3) controversial: no single response selected by a majority of respondents. RESULTS Consensus treatment indications included: radioresistant primary, 1–2 levels of adjacent disease, and previous radiation therapy. Contraindications included: involvement of more than 3 contiguous vertebral bodies, ASIA Grade A status (complete spinal cord injury without preservation of motor or sensory function), and postoperative Bilsky Grade 3 residual (cord compression without any CSF around the cord). For treatment planning, co-registration of the preoperative MRI and postoperative T1-weighted MRI (with or without gadolinium) and delineation of the cord on the T2-weighted MRI (and/or CT myelogram in cases of significant hardware artifact) were predominant. Consensus GTV (gross tumor volume) was the postoperative residual tumor based on MRI. Predominant CTV (clinical tumor volume) practice was to include the postoperative bed defined as the entire extent of preoperative tumor, the relevant anatomical compartment and any residual disease. Consensus was achieved with respect to not including the surgical hardware and incision in the CTV. PTV (planning tumor volume) expansion was controversial, ranging from 0 to 2 mm. The spinal cord avoidance structure was predominantly the true cord. Circumferential treatment of the epidural space and margin for paraspinal extension was controversial. Prescription doses and spinal cord tolerances based on clinical scenario, neurological compromise, and prior overlapping treatments were controversial, but reasonable ranges are presented. Fifty percent of those surveyed practiced an integrated boost to areas of residual tumor and density override for hardware within the beam path. Acceptable PTV coverage was controversial, but consensus was achieved with respect to compromising coverage to meet cord constraint and fractionation to improve coverage while meeting cord constraint. CONCLUSIONS The consensus by spinal radiosurgery experts suggests that postoperative SBRT is indicated for radioresistant primary lesions, disease confined to 1–2 vertebral levels, and/or prior overlapping radiotherapy. The GTV is the postoperative residual tumor, and the CTV is the postoperative bed defined as the entire extent of preoperative tumor and anatomical compartment plus residual disease. Hardware and scar do not need to be included in CTV. While predominant agreement was reached about treatment planning and definition of organs at risk, future investigation will be critical in better understanding areas of controversy, including whether circumferential treatment of the epidural space is necessary, management of paraspinal extension, and the optimal dose fractionation schedules.
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Fischman, Victoria, Vladimir Ivanovic, and Scharukh Jalisi. "A Bioresorbable Fiducial for Head and Neck Cancer." Otolaryngology–Head and Neck Surgery 163, no. 3 (May 19, 2020): 554–56. http://dx.doi.org/10.1177/0194599820921864.
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We aim to evaluate a novel bioresorbable fiducial for marking tumor bed margins in head and neck cancers (HNCs) to improve upon current use of nonresorbable materials. A feasibility test was done placing the marker (L-lactide and ε-caprolactone) in an orange for computed tomography (CT) and applesauce for T1-, T2-, and PD-weighted magnetic resonance imaging (MRI) image acquisition, using routine clinical parameters. The resulting CT and MRI images showed excellent delineation of the marker with all of its margins well seen without adjacent artifact. The marker appeared similar to air on CT and MRI, surrounded by fluid-like appearance of the medium. Surgical bed appearance when radiotherapy is planned should not produce any artifact near the marker, and there should be no inherent marker-related artifact. These pilot CT and MR images show clinical utility for intraoperative marking of positive margins in the skull base or neck to guide future treatment and monitoring.
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Kurita, Hiroshi, Hironori Sakai, Takahiro Kamata, Takeshi Koike, Hiroichi Kobayashi, and Kenji Kurashina. "Accuracy of intraoperative tissue staining in delineating deep surgical margins in oral carcinoma surgery." Oral Oncology 44, no. 10 (October 2008): 935–40. http://dx.doi.org/10.1016/j.oraloncology.2007.12.008.
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Takeuchi, Mayumi, Kenji Matsuzaki, Yoshimi Bando, and Masafumi Harada. "Reduced field-of-view diffusion-weighted MR imaging for assessing the local extent of uterine cervical cancer." Acta Radiologica 61, no. 2 (June 1, 2019): 267–75. http://dx.doi.org/10.1177/0284185119852733.
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Background Recently, the evaluation of the tumor size and local extension of early-stage uterine cervical cancer on magnetic resonance imaging is important for the accurate clinical staging and to determine the indication of less extensive surgery such as fertility sparing radical trachelectomy. Purpose To compare the diagnostic ability of reduced field-of-view diffusion-weighted imaging with those of three-dimensional (3D) contrast-enhanced T1-weighted imaging and T2-weighted imaging for assessing the tumor margin delineation and local extent of uterine cervical cancer. Material and Methods 3T magnetic resonance images, including T2-weighted imaging, reduced field-of-view diffusion-weighted imaging, and 3D contrast-enhanced T1-weighted imaging, in 27 women with surgically proven cervical cancer (19 FIGO stage IB1, 3 IB2, and 5 IIA1) were retrospectively evaluated. Tumor margins and local tumor extent, including the presence of invasion to parametrium and vagina were evaluated on both sagittal and oblique axial (short axis) images; the results were compared with histologically confirmed tumor extension. Results Reduced field-of-view diffusion-weighted imaging diagnosed the tumor margins, which was more accurate than T2-weighted imaging ( P<0.001) and slightly better than 3D contrast-enhanced T1-weighted imaging. Reduced field-of-view diffusion-weighted imaging could define the tumor margins well even in small lesions (≤ 20 mm). Histological examination revealed parametrial invasion in two cases (clinically under-staged) and vaginal invasion in four cases. Reduced field-of-view diffusion-weighted imaging could demonstrate local extension of all lesions, which was more accurate than clinical examination and T2-weighted imaging. Conclusion Addition of reduced field-of-view diffusion-weighted imaging may improve the staging accuracy of magnetic resonance imaging for cervical cancer in assessing the local tumor extent.
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OTA, Yoshihide, Takayuki AOKI, Kazunari KARAKIDA, Daisuke WATANABE, Hiroshi YAMAZAKI, Ikuko ARAI, Ryou SEKIYA, and Keiichi TSUKINOKI. "DELINEATION OF THE SURGICAL MARGINS OF SOFT TISSUE IN THE SURGICAL PROCEDURE FOR GINGIVAL CANCER OF MANDIBLE, BASED ON THE DEPTH OF INVASION." Japanese jornal of Head and Neck Cancer 27, no. 1 (2001): 38–43. http://dx.doi.org/10.5981/jjhnc1974.27.38.
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Blitzer, Grace C., Poonam Yadav, and Zachary S. Morris. "The Role of MRI-Guided Radiotherapy for Soft Tissue Sarcomas." Journal of Clinical Medicine 11, no. 4 (February 17, 2022): 1042. http://dx.doi.org/10.3390/jcm11041042.
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Soft tissue sarcomas (STS) are a rare class of tumors that originate from mesenchymal tissues and occur most frequently in the extremities, trunk, and retroperitoneum. Surgical resection with R0 margins is the primary curative treatment for most localized STS. In this setting, radiation therapy is used either pre-operatively or post-operatively to reduce the rate of local recurrence. Modern pre- or post-operative radiation therapy rely on the use of MRI sequences to guide target delineation during treatment planning. MRI-guided radiotherapy also offers unique advantages over CT-guided approaches in differentiating STS from surrounding normal soft tissues and enabling better identification of target volumes on daily imaging. For patients with unresectable STS, radiation therapy may offer the best chance for local tumor control. However, most STS are relatively radioresistant with modest rates of local control achieved using conventionally fractionated radiation. Specialized techniques such as hypofractionated radiation may allow for dose intensification and may increase rates of local control for STS. In these settings, MRI becomes even more critical for the delineation of targets and organs at risk and management of tumor and organ at risk motion during and between radiotherapy treatment fractions.
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Ponisio, Maria R., Jonathan E. McConathy, Sonika M. Dahiya, Michelle M. Miller-Thomas, Keith M. Rich, Amber Salter, Qing Wang, Pamela J. LaMontagne, Gloria J. Guzmán Pérez-Carrillo, and Tammie L. S. Benzinger. "Dynamic 18F-FDOPA-PET/MRI for the preoperative evaluation of gliomas: correlation with stereotactic histopathology." Neuro-Oncology Practice 7, no. 6 (August 7, 2020): 656–67. http://dx.doi.org/10.1093/nop/npaa044.
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Abstract Background MRI alone has limited accuracy for delineating tumor margins and poorly predicts the aggressiveness of gliomas, especially when tumors do not enhance. This study evaluated simultaneous 3,4-dihydroxy-6-[18F]fluoro-L-phenylalanine (FDOPA)-PET/MRI to define tumor volumes compared to MRI alone more accurately, assessed its role in patient management, and correlated PET findings with histopathology. Methods Ten patients with known or suspected gliomas underwent standard of care surgical resection and/or stereotactic biopsy. FDOPA-PET/MRI was performed prior to surgery, allowing for precise co-registration of PET, MR, and biopsies. The biopsy sites were modeled as 5-mm spheres, and the local FDOPA uptake at each site was determined. Correlations were performed between measures of tumor histopathology, and static and dynamic PET values: standardized uptake values (SUVs), tumor to brain ratios, metabolic tumor volumes, and tracer kinetics at volumes of interest (VOIs) and biopsy sites. Results Tumor FDOPA-PET uptake was visualized in 8 patients. In 2 patients, tracer uptake was similar to normal brain reference with no histological findings of malignancy. Eight biopsy sites confirmed for glioma had FDOPA uptake without T1 contrast enhancement. The PET parameters were highly correlated only with the cell proliferation marker, Ki-67 (SUVmax: r = 0.985, P = .002). In this study, no statistically significant difference between high-grade and low-grade tumors was demonstrated. The dynamic PET analysis of VOIs and biopsy sites showed decreasing time-activity curves patterns. FDOPA-PET imaging directly influenced patient management. Conclusions Simultaneous FDOPA-PET/MRI allowed for more accurate visualization and delineation of gliomas, enabling more appropriate patient management and simplified validation of PET findings with histopathology.
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Casiano, Roy R., and Jonathan Cooper. "Anterior Table Free Bone Graft Technique for Frontal Sinus Obliteration." Otolaryngology–Head and Neck Surgery 106, no. 4 (April 1992): 363–66. http://dx.doi.org/10.1177/019459989210600408.
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The osteoplastic flap technique for exposure of the frontal sinus has been an accepted approach for cases in which obliteration or exploration of the frontal sinus has been necessary. Preservation of vascularized anterior pericranium is credited with reduction of the chances of anterior table bone resorption and subsequent cosmetic deformity. Disadvantages include the need for templates and unpredictable random fracturing in the supraorbital rim area, increasing the chance of potential injury to the periorbita and/or supraorbital neurovascular structures as well as limiting surgical exposure in some cases. Ten patients with chronic frontal sinusitis underwent frontal sinus obliteration using an anterior fable free bone graft technique over a 3 year period. The superior orbital neurovascular pedicles were easily identified and protected within its pericranial sheath in all cases. All patients had precise delineation of the frontal sinus anterior bone flap margins with no need for templates. Bone graft viability was documented in all patients, along with excellent cosmetic results comparable to the osteoplastic flap technique. A review of the literature and description of the technique are presented.
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Chirkov, Valerii, Anna Kryuchkova, Alexandra Koptelova, Tatiana Stroganova, Alexandra Kuznetsova, Daria Kleeva, Alexei Ossadtchi, and Tommaso Fedele. "Data-driven approach for the delineation of the irritative zone in epilepsy in MEG." PLOS ONE 17, no. 10 (October 25, 2022): e0275063. http://dx.doi.org/10.1371/journal.pone.0275063.
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The reliable identification of the irritative zone (IZ) is a prerequisite for the correct clinical evaluation of medically refractory patients affected by epilepsy. Given the complexity of MEG data, visual analysis of epileptiform neurophysiological activity is highly time consuming and might leave clinically relevant information undetected. We recorded and analyzed the interictal activity from seven patients affected by epilepsy (Vectorview Neuromag), who successfully underwent epilepsy surgery (Engel > = II). We visually marked and localized characteristic epileptiform activity (VIS). We implemented a two-stage pipeline for the detection of interictal spikes and the delineation of the IZ. First, we detected candidate events from peaky ICA components, and then clustered events around spatio-temporal patterns identified by convolutional sparse coding. We used the average of clustered events to create IZ maps computed at the amplitude peak (PEAK), and at the 50% of the peak ascending slope (SLOPE). We validated our approach by computing the distance of the estimated IZ (VIS, SLOPE and PEAK) from the border of the surgically resected area (RA). We identified 25 spatiotemporal patterns mimicking the underlying interictal activity (3.6 clusters/patient). Each cluster was populated on average by 22.1 [15.0–31.0] spikes. The predicted IZ maps had an average distance from the resection margin of 8.4 ± 9.3 mm for visual analysis, 12.0 ± 16.5 mm for SLOPE and 22.7 ±. 16.4 mm for PEAK. The consideration of the source spread at the ascending slope provided an IZ closer to RA and resembled the analysis of an expert observer. We validated here the performance of a data-driven approach for the automated detection of interictal spikes and delineation of the IZ. This computational framework provides the basis for reproducible and bias-free analysis of MEG recordings in epilepsy.
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Bhatnagar, Ajay K., Dwight E. Heron, and Barry Schaitkin. "Perineural Invasion of Squamous Cell Carcinoma of the Lip with Occult Involvement of the Infra-orbital Nerve Detected by PET-CT and Treated with MRI-based IMRT: A Case Report." Technology in Cancer Research & Treatment 4, no. 3 (June 2005): 251–53. http://dx.doi.org/10.1177/153303460500400304.
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A 51 year old male with a history of right facial numbness developed progressive upper lip swelling for one year, but an MRI of the head was unremarkable. A wide local excision of the upper lip was performed and pathology revealed a 1.7 cm mass, poorly differentiated squamous cell carcinoma with perineural invasion. Surgical margins were free of tumor. Two months postoperatively, a hybrid PET-CT of the whole body was performed due to the persistent right facial numbness. The CT portion identified an equivocal lesion at the base of the right orbit correlating to the right infraorbital nerve. However, the PET-CT image revealed avid uptake in this location suggesting perineural invasion which was confirmed with biopsy of the right infraorbital nerve demonstrating carcinoma. Subsequently, the patient was treated with Intensity Modulation Radiation Therapy (IMRT) using MRI fusion for proper delineation of the right infraorbital nerve to its origin in the base of skull. This case exemplifies the superiority of hybrid PET-CT over CT or MRI alone in head and neck imaging which can lead to significant impact on management for patients with head and neck cancer.
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Silva, Melissa, Catalina Vivancos, and Hugues Duffau. "The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude." Brain Sciences 12, no. 4 (April 15, 2022): 504. http://dx.doi.org/10.3390/brainsci12040504.
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Diffuse low-grade gliomas (DLGGs) are heterogeneous and poorly circumscribed neoplasms with isolated tumor cells that extend beyond the margins of the lesion depicted on MRI. Efforts to demarcate the glioma core from the surrounding healthy brain led us to define an intermediate region, the so-called peritumoral zone (PTZ). Although most studies about PTZ have been conducted on high-grade gliomas, the purpose here is to review the cellular, metabolic, and radiological characteristics of PTZ in the specific context of DLGG. A better delineation of PTZ, in which glioma cells and neural tissue strongly interact, may open new therapeutic avenues to optimize both functional and oncological results. First, a connectome-based “supratotal” surgical resection (i.e., with the removal of PTZ in addition to the tumor core) resulted in prolonged survival by limiting the risk of malignant transformation, while improving the quality of life, thanks to a better control of seizures. Second, the timing and order of (neo)adjuvant medical treatments can be modulated according to the pattern of peritumoral infiltration. Third, the development of new drugs specifically targeting the PTZ could be considered from an oncological (such as immunotherapy) and epileptological perspective. Further multimodal investigations of PTZ are needed to maximize long-term outcomes in DLGG patients.
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Houghton, Jacob L., Brian M. Zeglis, Dalya Abdel-Atti, Robert Aggeler, Ritsuko Sawada, Brian J. Agnew, Wolfgang W. Scholz, and Jason S. Lewis. "Site-specifically labeled CA19.9-targeted immunoconjugates for the PET, NIRF, and multimodal PET/NIRF imaging of pancreatic cancer." Proceedings of the National Academy of Sciences 112, no. 52 (December 14, 2015): 15850–55. http://dx.doi.org/10.1073/pnas.1506542112.
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Molecular imaging agents for preoperative positron emission tomography (PET) and near-infrared fluorescent (NIRF)-guided delineation of surgical margins could greatly enhance the diagnosis, staging, and resection of pancreatic cancer. PET and NIRF optical imaging offer complementary clinical applications, enabling the noninvasive whole-body imaging to localize disease and identification of tumor margins during surgery, respectively. We report the development of PET, NIRF, and dual-modal (PET/NIRF) imaging agents, using 5B1, a fully human monoclonal antibody that targets CA19.9, a well-established pancreatic cancer biomarker. Desferrioxamine (DFO) and/or a NIRF dye (FL) were conjugated to the heavy-chain glycans of 5B1, using a robust and reproducible site-specific (ss) labeling methodology to generate three constructs (ssDFO-5B1, ssFL-5B1, and ssdual-5B1) in which the immunoreactivity was not affected by the conjugation of either label. Each construct was evaluated in a s.c. xenograft model, using CA19.9-positive (BxPC3) and -negative (MIAPaCa-2) human pancreatic cancer cell lines. Each construct showed exceptional uptake and contrast in antigen-positive tumors with negligible nonspecific uptake in antigen-negative tumors. Additionally, the dual-modal construct was evaluated in an orthotopic murine pancreatic cancer model, using the human pancreatic cancer cell line, Suit-2. The ssdual-5B1 demonstrated a remarkable capacity to delineate metastases and to map the sentinel lymph nodes via tandem PET-computed tomography (PET/CT) and NIRF imaging. Fluorescence microscopy, histopathology, and autoradiography were performed on representative sections of excised tumors to visualize the distribution of the constructs within the tumors. These imaging tools have tremendous potential for further preclinical research and for clinical translation.
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Endo, Toshiki, Misaki Aizawa-Kohama, Kenichi Nagamatsu, Kensuke Murakami, Akira Takahashi, and Teiji Tominaga. "Use of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of intramedullary cavernous malformations: report of 8 cases." Journal of Neurosurgery: Spine 18, no. 5 (May 2013): 443–49. http://dx.doi.org/10.3171/2013.1.spine12482.
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Object The characteristics and efficacy of indocyanine green (ICG) videoangiography in cavernous malformation (CM) have not been fully elucidated. The purpose of this paper is to examine the potential utility of ICG videoangiography in the surgical treatment of intramedullary CMs. Methods The authors conducted a retrospective review of 8 cases involving 5 men and 3 women who had undergone surgery for intramedullary CM between January 2008 and July 2011. All patients were evaluated by means of MRI. The MRI findings and clinical history in all cases suggested intramedullary CM as a preoperative diagnosis. In 2 of 8 cases, dilated venous structures associated with CMs were demonstrated. In one of these cases, there were coexisting extramedullary CMs. Intraoperatively, ICG fluorescence was observed for 5 minutes using microscope-integrated videoangiography. Results In all 8 cases, intra- and extramedullary CMs were seen as avascular areas on ICG videoangiography. Indocyanine green videoangiography helped surgeons to localize and predict margins of the lesions before performing myelotomy. Importantly, in the cases with associated venous anomalies, ICG videoangiography was useful in delineating and preserving the venous structures. In extramedullary CMs located dorsal to the spinal cord, gradual ICG infiltration was seen, starting at 110 seconds and maximal at 210 seconds after injection. Postoperative MRI confirmed total removal of the lesions in all cases, and subsequent recovery of all patients was uneventful. Conclusions Indocyanine green videoangiography provided useful information with regard to the detection of lesion margins by demonstrating intramedullary CMs as avascular areas. In cases associated with venous anomalies, ICG contributed to safe and complete removal of the CMs by visualizing the venous structure. In extramedullary CMs, ICG videoangiography demonstrated the characteristic of slow blood flow within CMs.
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Muoio, Barbara, Luca Giovanella, and Giorgio Treglia. "Recent Developments of 18F-FET PET in Neuro-oncology." Current Medicinal Chemistry 25, no. 26 (September 4, 2018): 3061–73. http://dx.doi.org/10.2174/0929867325666171123202644.
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Background: From the past decade to date, several studies related to O-(2- [18F]fluoroethyl)-L-tyrosine (18F-FET) positron emission tomography (PET) in brain tumours have been published in the literature. Objective: The aim of this narrative review is to summarize the recent developments and the current role of 18F-FET PET in brain tumours according to recent literature data. Methods: Main findings from selected recently published and relevant articles on the role of 18F-FET PET in neuro-oncology are described. Results: 18F-FET PET may be useful in the differential diagnosis between brain tumours and non-neoplastic lesions and between low-grade and high-grade gliomas. Integration of 18F-FET PET into surgical planning allows better delineation of the extent of resection beyond margins visible with standard MRI. For biopsy planning, 18F-FET PET is particularly useful in identifying malignant foci within non-contrast-enhancing gliomas. 18F-FET PET may improve the radiation therapy planning in patients with gliomas. This metabolic imaging method may be useful to evaluate treatment response in patients with gliomas and it improves the differential diagnosis between brain tumours recurrence and posttreatment changes. 18F-FET PET may provide useful prognostic information in high-grade gliomas. Conclusion: Based on recent literature data 18F-FET PET may provide additional diagnostic information compared to standard MRI in neuro-oncology.
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Cassarino, Gianluca, Laura Evangelista, Chiara Giraudo, Alfio Capizzi, Giovanni Carretta, Pietro Zucchetta, and Diego Cecchin. "18F-FDG PET/MRI in adult sarcomas." Clinical and Translational Imaging 8, no. 6 (October 20, 2020): 405–12. http://dx.doi.org/10.1007/s40336-020-00395-9.
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Abstract Aim This mini-review aims to summarize the main findings on PET/MRI in patients with sarcomas. Materials and methods A literature search was carried out on MEDLINE databases, such as PubMed, Scopus, Web of Science and Google Scholar, using the search terms “PET”, “positron emission tomography”, “PET/MRI”, “positron emission tomography/magnetic resonance imaging”, and “sarcoma”. No restrictions (i.e. language, age, type of manuscript, or the like) were applied to the search strategy. Abstracts, reviews, letters to editors, and editorials were excluded. Results Eight studies were ultimately included. From 2013 to 2019, a total of 154 adult patients with sarcomas underwent 18F-fluorodeoxyglucose (18F-FDG) PET/MRI. Of these patients, 129 had soft tissue sarcomas (STS), 5 had bone sarcomas, and 20 had cardiac masses. Thirty-two patients had PET/MRI for early-stage disease, 45 for recurrences, and 57 for the assessment of response to treatment. For staging purposes, the studies suggest that PET/MRI can significantly improve the delineation of surgical margins. At restaging, PET/MRI can also detect sarcoma recurrences more accurately than conventional imaging. Conclusions 18F-FDG PET/MRI has promising indications in patients with sarcomas, from disease staging to the assessment of response to treatment. Further studies are warranted to confirm these results, especially in subgroups with specific histopathological features.
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Yong, Doh Jeing, Abd Majid Md Nasir, and Bee See Goh. "Middle Ear Carcinoma Masquerading as an Aural Polyp." Philippine Journal of Otolaryngology-Head and Neck Surgery 27, no. 2 (December 3, 2012): 17–19. http://dx.doi.org/10.32412/pjohns.v27i2.523.
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Objective: To present a case of middle ear carcinoma masquerading as an aural polyp and describe our experience with the clinical presentation, management and outcome of an elderly patient with this pathology.
Methods:
Design: Case Report
Setting: Tertiary Public Hospital
Patients: One
Result: A 63-year-old female presented with an aural polyp and preceding symptoms of inner ear disturbances followed by otorrhea and otalgia. CT scans revealed an erosive lesion occupying the entire middle ear cleft, external ear canal and mastoid cavity with involvement of inner structures. A repeat biopsy subsequently revealed malignancy leading to a diagnosis of middle ear carcinoma. The patient was offered surgical treatment but opted for radiotherapy and subsequently defaulted follow-up.
Conclusion: Middle ear carcinoma is rare and can masquerade as a benign aural polyp. Symptoms of severe otalgia and inner ear disturbances are indicators of possible malignancy, as are recent-onset symptoms of otitis media developing over a relatively short course later in life. A high index of suspicion is needed to avoid late diagnosis. Repeat deeper aural tissue biopsy is needed to exclude malignancy. Computed tomography imaging is indispensable in delineating tumor extent and aids in tumor staging as well as prognostication. Surgical resection with clear tumor margins, followed by postoperative radiotherapy, is the preferred choice of treatment. Sole radiotherapy is reserved for tumors of small volume as well as in cases where surgery is not feasible.
Keywords: Middle ear carcinoma; aural polyp; temporal bone carcinoma
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Inoue, Tomoo, Toshiki Endo, Kenichi Nagamatsu, Mika Watanabe, and Teiji Tominaga. "5-Aminolevulinic Acid Fluorescence-Guided Resection of Intramedullary Ependymoma: Report of 9 Cases." Operative Neurosurgery 72, no. 2 (November 12, 2012): ons159—ons168. http://dx.doi.org/10.1227/neu.0b013e31827bc7a3.
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Abstract BACKGROUND: Resection guided by 5-aminolevulinic acid (5-ALA) fluorescence has proved to be useful in intracranial glioma surgery. However, the effects of 5-ALA on spinal cord tumors remain unknown. OBJECTIVE: To evaluate the usefulness of 5-ALA fluorescence-guided resection of intramedullary ependymoma for achieving maximum tumor resection. METHODS: This study included 10 patients who underwent surgical resection of an intramedullary ependymoma. Nine patients were orally administered 5-ALA (20 mg/kg) 2 hours before the induction of anesthesia. 5-ALA fluorescence was visualized with an operating microscope. Tumors were removed in a standardized manner with electro-physiological monitoring. The extent of resection was evaluated on the basis of intra-operative findings and postoperative magnetic resonance imaging. Histopathological diagnosis was established according to World Health Organization 2007 criteria. Cell proliferation was assessed by Ki-67 labeling index. RESULTS: 5-ALA fluorescence was positive in 7 patients (6 grade II and 1 grade III) and negative in 2 patients (grade II). Intraoperative findings were dichotomized: Tumors covered by the cyst were easily separated from the normal parenchyma, whereas tumors without the cyst appeared to be continuous to the spinal cord. In these cases, 5-ALA fluorescence was especially valuable in delineating the ventral and cranial and caudal margins. Ki-67 labeling index was significantly higher in 5-ALA-positive cases compared with 5-ALA-negative cases. All patients improved neurologically or stabilized after surgery. CONCLUSION: 5-ALA fluorescence was useful for detecting tumor margins during surgery for intramedullary ependymoma. When combined with electrophysiological monitoring, fluorescence-guided resection could help to achieve maximum tumor resection safely.
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Margolis, Daniel, Nelly Tan, Shyam Natarajan, Karim Chamie, David Finley, Robert Evan Reiter, Jiaoti Huang, and Steven Raman. "Value of prostate MRI in determining appropriate candidates for active surveillance." Journal of Clinical Oncology 30, no. 5_suppl (February 10, 2012): 109. http://dx.doi.org/10.1200/jco.2012.30.5_suppl.109.
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109 Background: The objective was to measure the added benefit of multi-parametric endorectal coil prostate MRI (eMRI) to traditional active (AS) criteria in delineating men with more advanced disease. Methods: We performed a retrospective study of 115 men who underwent robot-assisted laparoscopic prostatectomy (RALP) for their CaP with whole-mount pathological evaluation. All men underwent eMRI for surgical planning—including T2 weighted, diffusion-weighted (DWI), dynamic contrast-enhanced (DCE), and MR Spectroscopy—between July 2008 and March 2011. We examined the diagnostics of Epstein’s criteria (E-AS) for clinically insignificant CaP or in combination with MR parameters (eMRI-AS criteria) in predicting more advanced disease. E-AS criteria included Gleason score (GS) 3+3=6, <3 biopsy cores positive, PSA <10, ≤50% maximum % of cancer in any one core. The addition of apparent diffusion coefficient >0.85x10-3 mm2/sec, Ktrans<0.5 Hz, Kep>1.5 Hz, and normal MRSI defined the eMRI-AS cohort. Outcomes were stratified into low vs. high surgical risk. Low-risk disease was defined as having pT2, GS <3+4 with tumor size <1.5 cm, and negative surgical margins (SM). Conversely, higher-risk disease included men with GS ≥4+3, positive SM, ≥pT3 or those with GS 3+4 with tumor size ≥1.5 cm. Results: We identified 104 who met our inclusion criteria. We excluded 11 (9%) men due to post-biopsy hemorrhage (n=4), failed DCE (n=4), poor DWI (n=2), and two-year delay between MRI and RALP (n=1). Mean age was 60.6 years. Thirty-seven men (35%) satisfied E-AS, while 25 men (24%) satisfied eMRI-AS. On whole-mount sectioning 49 (47%) men were low surgical risk. E-AS to detect low surgical risk revealed a sensitivity, specificity, false positive, false negative and AUC of 67%, 73%, 33%, 27%, and 70%, respectively. eMRI-AS performance parameters were: 62.8%, 94.4%, 37%, 5% and 78%—significantly different than E-AS (p=0.04). Conclusions: eMRI-AS outperformed Epstein-AS in identifying poor candidates from going onto AS. If patients were identified as AS candidates based on traditional criteria, we found that 27% actually had higher risk disease; whereas the addition of eMRI reduced this number to 5%.
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Tilbury, Karissa, and Paul J. Campagnola. "Applications of Second-Harmonic Generation Imaging Microscopy in Ovarian and Breast Cancer." Perspectives in Medicinal Chemistry 7 (January 2015): PMC.S13214. http://dx.doi.org/10.4137/pmc.s13214.
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In this perspective, we discuss how the nonlinear optical technique of second-harmonic generation (SHG) microscopy has been used to greatly enhance our understanding of the tumor microenvironment (TME) of breast and ovarian cancer. Striking changes in collagen architecture are associated with these epithelial cancers, and SHG can image these changes with great sensitivity and specificity with submicrometer resolution. This information has not historically been exploited by pathologists but has the potential to enhance diagnostic and prognostic capabilities. We summarize the utility of image processing tools that analyze fiber morphology in SHG images of breast and ovarian cancer in human tissues and animal models. We also describe methods that exploit the SHG physical underpinnings that are effective in delineating normal and malignant tissues. First we describe the use of polarization-resolved SHG that yields metrics related to macromolecular and supramolecular structures. The coherence and corresponding phase-matching process of SHG results in emission directionality (forward to backward), which is related to sub-resolution fibrillar assembly. These analyses are more general and more broadly applicable than purely morphology-based analyses; however, they are more computationally intensive. Intravital imaging techniques are also emerging that incorporate all of these quantitative analyses. Now, all these techniques can be coupled with rapidly advancing miniaturization of imaging systems to afford their use in clinical situations including enhancing pathology analysis and also in assisting in real-time surgical determination of tumor margins.
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Sato, Nobuaki. "In-breast tumor recurrence rate of breast CT-guided lumpectomy: A prospective multi-institutional study in Japan." Journal of Clinical Oncology 30, no. 27_suppl (September 20, 2012): 170. http://dx.doi.org/10.1200/jco.2012.30.27_suppl.170.
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170 Background: We have conducted the prospective multicenter study to evaluate the usefulness of breast CT in delineating tumor extent and preoperatively determining the optimal surgical procedure (Sadako Akashi-Tanaka et al, Ann Surg in press). Breast CT, carried out in the supine position, was useful since breast CT correctly changed the extent of surgery in 13.1% of patients. Here, we present the in-breast tumor recurrence (IBTR) of these patients undergoing CT guided breast conserving surgery. Methods: The follow-up records of 271 women treated with local excision (complete removal of gross tumor with a margin) for breast cancer at 3 Japanese hospitals were reviewed. CT guided surgery was performed as follows; the surgeon marked the line of planned excision prior to CT on the skin, which was also recorded on the CT image. Contrast-enhanced breast CT was performed in the supine surgical position. The CT results were used to determine the extent of surgery. IBTR was defined as a recurrence in the treated breast without regional or distant metastases. Results: The median age at surgery of them was 55 years (range, 21 to 88 years). The median palpable tumor size was 1.6cm (range, 0 to 3.5 cm). Tumor histology was as follows: ductal carcinoma in situ 13, invasive ductal carcinoma 234, invasive lobular carcinoma 10, mucinous carcinoma 6, and special type 8. The median follow-up after treatment was 3.8 years (range, 3.0 to 5.3 years). The rate of IBTR was 10/271 (3.7%). The 3.8-year rate of IBTR was 4.5%. Discussion: Without prospective randomized controlled studies, it is unlikely that a definitive conclusion can be reached on whether imaging-guided diagnosis of tumor extent will reduce the rate of IBTR. However, it seems almost ethically impossible to conduct such a clinical study in Japan, because preoperative imaging-guided diagnosis of tumor extent is routinely performed prior to surgery. Conclusions: Although this was not the randomized controlled study, CT-based preoperative diagnosis of tumor extent has the potential to improve the accuracy of breast-conserving surgery. The long-term results of IBTR need to be assessed.
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Harms, Steven, Gail Lebovic, Cary Steven Kaufman, and Michael Cross. "Mammographic imaging after partial breast reconstruction: Impact of a bioabsorbable breast implant." Journal of Clinical Oncology 33, no. 28_suppl (October 1, 2015): 111. http://dx.doi.org/10.1200/jco.2015.33.28_suppl.111.
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111 Background: Marking the site of the excised tumor bed during partial mastectomy is critical for radiation targeting and surveillance for breast cancer recurrence. However, delineating the lumpectomy cavity margins is challenging, and dense fibrosis and scarring often present obstacles when reviewing post-operative mammograms for signs of early recurrence. To determine whether implantation of a "mini" breast implant used for partial breast reconstruction adversely affected post-operative breast imaging, we reviewed clinical imaging of 100 patients that had been implanted with a new bioabsorbable breast implant over a three year period. Methods: Following informed consent, 110 patients were implanted at the time of partial mastectomy with a bioabsorbable implant with a primary purpose of marking the surgical site of tumor excision for radiotherapy. In each case, the surgeon sutured the implant into the cavity at the location believed to be at greatest risk for recurrence. Implants were used for partial breast reconstruction, a guide for radiation treatment planning and routine mammographic follow-up. Mammograms were reviewed for implant visibility, presence of artifacts and other diagnostic criteria. Results: In all cases the implant was rated as easily visible on mammography and CT without appreciable artifact or interference with diagnostic capabilities. In addition, there was notably less dense fibrotic tissue visualized on mammographic imaging at the tumor excision site containing the implant. In some cases, the marker clips coalesced in the center of the surgical cavity. The marker was also seen on US and MRI during routine follow-up. Conclusions: Mammographic imaging in patients implanted with this new device was not adversely affected by its presence. The implant visually assisted with verification of the excised tumor bed without introducing any artifact or diagnostic interference and there was notable in-growth of normal breast tissue clearly seen on mammography. In this group of patients there were no abnormal calcifications in or around the implant and there were no recurrent cancers detected within this 36 month period.
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Gulia, Ashish, Ajay Puri, T. S. Subi, Srinath M. Gupta, S. L. Juvekar, and Bharat Rekhi. "Comparison of MRI and Histopathology with regard to Intramedullary Extent of Disease in Bone Sarcomas." Sarcoma 2019 (November 29, 2019): 1–5. http://dx.doi.org/10.1155/2019/7385470.
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In today’s era, limb salvage surgery is the procedure of choice and current standard of care in appropriately selected patients of bone sarcomas. For adequate oncologic clearance, preoperative evaluation of the extent of tumor is mandatory. The present study was done to compare measurements of bone sarcomas (osteosarcoma, Ewing’s sarcoma, and chondrosarcoma) as determined by magnetic resonance imaging (MRI) with the histopathological extent seen on resected specimens. We prospectively evaluated 100 consecutive patients with a diagnosis of bone sarcoma who underwent limb salvage surgery between May 2014 and December 2014. The maximum longitudinal (cranio-caudal) dimension of tumor on the noncontrast T1-WI sequence of MRI (irrespective of whether it was pre/postchemotherapy) was compared with the gross dimensions of the tumor on histopathology. The arithmetic mean difference, Wilcoxon signed-rank test, and Spearman’s correlation analysis were used to test the differences and correlation between groups. Mean tumor size on MRI based on the largest extent on MRI was 12.1 ± 4.85 cm (mean ± standard deviation), while it was 10.77 ± 4.6 cm (mean ± standard deviation) on histopathology. In 79 cases, MRI overestimated the extent of disease; the mean was 1.79 cm with a standard deviation of 1.56 cm. When the disease extent was underestimated on MRI (13 cases), the mean was 0.58 cm with a standard deviation of 0.43 cm. In 8 cases (osteosarcoma (7), Ewing’s sarcoma (1)), MRI measurement was equal to histopathology. The Spearman correlation analysis showed a high correlation of tumor length on histopathology with the MRI for all patients (R = 0.948, P<0.0001). We thus conclude that MRI is accurate in delineating the extent of bone sarcomas. A margin of 2 cm from the maximum tumor extent is adequate to ensure appropriate surgical resection.
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Steinkamp, Pieter Jan, Floris Jan Voskuil, Bert van der Vegt, Jan Johannes Doff, Kees-Pieter Schepman, Sebastiaan Antonius Hendrik Johanne de Visscher, Wendy Kelder, et al. "A Standardized Framework for Fluorescence-Guided Margin Assessment for Head and Neck Cancer Using a Tumor Acidosis Sensitive Optical Imaging Agent." Molecular Imaging and Biology, May 24, 2021. http://dx.doi.org/10.1007/s11307-021-01614-z.
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Abstract Purpose Intra-operative management of the surgical margin in patients diagnosed with head and neck squamous cell carcinoma (HNSCC) remains challenging as surgeons still have to rely on visual and tactile information. Fluorescence-guided surgery using tumor-specific imaging agents can assist in clinical decision-making. However, a standardized imaging methodology is lacking. In this study, we determined whether a standardized, specimen-driven, fluorescence imaging framework using ONM-100 could assist in clinical decision-making during surgery. Procedures Thirteen patients with histologically proven HNSCC were included in this clinical study and received ONM-100 24 ± 8 h before surgery. Fluorescence images of the excised surgical specimen and of the surgical cavity were analyzed. A fluorescent lesion with a tumor-to-background ratio (TBR) > 1.5 was considered fluorescence-positive and correlated to standard of care (SOC) histopathology. Results All six tumor-positive surgical margins were detected immediately after excision using fluorescence-guided intra-operative imaging. Postoperative analysis showed a median TBR (±IQR) of the fluorescent lesions on the resection margin of 3.36 ± 1.62. Three fluorescence-positive lesions in the surgical cavity were biopsied and showed occult carcinoma and severe dysplasia, and a false-positive fluorescence lesion. Conclusion Our specimen-driven fluorescence framework using a novel, pH-activatable, fluorescent imaging agent could assist in reliable and real-time adequate clinical decision-making showing that a fluorescent lesion on the surgical specimen with a TBR of 1.5 is correlated to a tumor-positive resection margin. The binary mechanism of ONM-100 allows for a sharp tumor delineation in all patients, giving the surgeon a clinical tool for real-time margin assessment, with a high sensitivity.
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Van Hese, Laura, Steven De Vleeschouwer, Tom Theys, Steffen Rex, Ron M. A. Heeren, and Eva Cuypers. "The diagnostic accuracy of intraoperative differentiation and delineation techniques in brain tumours." Discover Oncology 13, no. 1 (November 10, 2022). http://dx.doi.org/10.1007/s12672-022-00585-z.
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AbstractBrain tumour identification and delineation in a timeframe of seconds would significantly guide and support surgical decisions. Here, treatment is often complicated by the infiltration of gliomas in the surrounding brain parenchyma. Accurate delineation of the invasive margins is essential to increase the extent of resection and to avoid postoperative neurological deficits. Currently, histopathological annotation of brain biopsies and genetic phenotyping still define the first line treatment, where results become only available after surgery. Furthermore, adjuvant techniques to improve intraoperative visualisation of the tumour tissue have been developed and validated. In this review, we focused on the sensitivity and specificity of conventional techniques to characterise the tumour type and margin, specifically fluorescent-guided surgery, neuronavigation and intraoperative imaging as well as on more experimental techniques such as mass spectrometry-based diagnostics, Raman spectrometry and hyperspectral imaging. Based on our findings, all investigated methods had their advantages and limitations, guiding researchers towards the combined use of intraoperative imaging techniques. This can lead to an improved outcome in terms of extent of tumour resection and progression free survival while preserving neurological outcome of the patients.
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"Calibration of fluorescence imaging for tumor surgical margin delineation: multistep registration of fluorescence and histological images." Journal of Medical Imaging 6, no. 02 (May 11, 2019): 1. http://dx.doi.org/10.1117/1.jmi.6.2.025005.
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Taboni, Stefano, Marco Ferrari, Michael J. Daly, Harley H. L. Chan, Donovan Eu, Tommaso Gualtieri, Ashok R. Jethwa, et al. "Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study." Frontiers in Oncology 11 (November 11, 2021). http://dx.doi.org/10.3389/fonc.2021.747227.
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BackgroundThe resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical navigation with virtual endoscopy (3D-SNVE) may represent a step forward. This study aimed to demonstrate and quantify the benefits of this technology.Material and MethodFour maxillary tumor models with critical posterior extension were created in four artificial skulls (Sawbones®). Images were acquired with cone-beam computed tomography and the tumor and carotid were contoured. Eight head and neck surgeons were recruited for the simulations. Surgeons delineated the posterior margin of resection through a transnasal approach and avoided the carotid while establishing an adequate resection margin with respect to tumor extirpation. Three simulations were performed: 1) unguided: based on a pre-simulation study of cross-sectional imaging; 2) tumor-guided: guided by real-time tool tracking with 3D tumor and carotid rendering; 3) carotid-guided: tumor-guided with a 2-mm alert cloud surrounding the carotid. Distances of the planes from the carotid and tumor were classified as follows and the points of the plane were classified accordingly: “red”: through the carotid artery; “orange”: <2 mm from the carotid; “yellow”: >2 mm from the carotid and within the tumor or <5 mm from the tumor; “green”: >2 mm from the carotid and 5–10 mm from the tumor; and “blue”: >2 mm from the carotid and >10 mm from the tumor. The three techniques (unguided, tumor-guided, and carotid-guided) were compared.Results3D-SNVE for the transnasal delineation of the posterior margin in maxillary tumor models significantly improved the rate of margin-negative clearance around the tumor and reduced damage to the carotid artery. “Green” cuts occurred in 52.4% in the unguided setting versus 62.1% and 64.9% in the tumor- and carotid-guided settings, respectively (p < 0.0001). “Red” cuts occurred 6.7% of the time in the unguided setting versus 0.9% and 1.0% in the tumor- and carotid-guided settings, respectively (p < 0.0001).ConclusionsThis preclinical study has demonstrated that 3D-SNVE provides a substantial improvement of the posterior margin delineation in terms of safety and oncological adequacy. Translation into the clinical setting, with a meticulous assessment of the oncological outcomes, will be the proposed next step.
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Doolan, Brent J., Michelle Weaich, Joanne Mamo, and Monisha Gupta. "Autologous Non-Cultured Epidermal Cellular Grafting in the Surgical Treatment of Stable Vitiligo: The Skin Hospital Protocol." Dermatology, April 23, 2021, 1–3. http://dx.doi.org/10.1159/000515084.
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Autologous non-cultured epidermal cellular grafting is the treatment of choice for patients with stable refractory vitiligo. Recently, studies have shown cost-effective alternatives for this procedure, superseding previous techniques that required large research facilities or expensive pre-packaged kits. We provide modifications to current techniques, including the use of individual Petri dishes to allow for processing larger skin grafts, hyfrecation instead of conventional manual dermabrasion of the recipient site to reduce scar formation as well as better margin delineation, and an intravenous giving set with a filter for improved filtration of the mixed cell population. These modifications facilitated sufficient skin repigmentation in a cost-effective outpatient setting.
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Ling, Tingsheng, Lianlian Wu, Yiwei Fu, Qinwei Xu, Ping An, Jun Zhang, Shan Hu, et al. "A deep learning-based system for identifying differentiation status and delineating the margins of early gastric cancer in magnifying narrow-band imaging endoscopy." Endoscopy, July 28, 2020. http://dx.doi.org/10.1055/a-1229-0920.
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Abstract Background Accurate identification of the differentiation status and margins for early gastric cancer (EGC) is critical for determining the surgical strategy and achieving curative resection in EGC patients. The aim of this study was to develop a real-time system to accurately identify differentiation status and delineate the margins of EGC on magnifying narrow-band imaging (ME-NBI) endoscopy. Methods 2217 images from 145 EGC patients and 1870 images from 139 EGC patients were retrospectively collected to train and test the first convolutional neural network (CNN1) to identify EGC differentiation status. The performance of CNN1 was then compared with that of experts using 882 images from 58 EGC patients. Finally, 928 images from 132 EGC patients and 742 images from 87 EGC patients were used to train and test CNN2 to delineate the EGC margins. Results The system correctly predicted the differentiation status of EGCs with an accuracy of 83.3 % (95 % confidence interval [CI] 81.5 % – 84.9 %) in the testing dataset. In the man – machine contest, CNN1 performed significantly better than the five experts (86.2 %, 95 %CI 75.1 % – 92.8 % vs. 69.7 %, 95 %CI 64.1 % – 74.7 %). For delineating EGC margins, the system achieved an accuracy of 82.7 % (95 %CI 78.6 % – 86.1 %) in differentiated EGC and 88.1 % (95 %CI 84.2 % – 91.1 %) in undifferentiated EGC under an overlap ratio of 0.80. In unprocessed EGC videos, the system achieved real-time diagnosis of EGC differentiation status and EGC margin delineation in ME-NBI endoscopy. Conclusion We developed a deep learning-based system to accurately identify differentiation status and delineate the margins of EGC in ME-NBI endoscopy. This system achieved superior performance when compared with experts and was successfully tested in real EGC videos.
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Chiesa, S., R. Russo, F. Beghella Bartoli, I. Palumbo, G. Sabatino, M. C. Cannatà, R. Gigli, et al. "MRI-derived radiomics to guide post-operative management of glioblastoma: Implication for personalized radiation treatment volume delineation." Frontiers in Medicine 10 (January 19, 2023). http://dx.doi.org/10.3389/fmed.2023.1059712.
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BackgroundThe glioblastoma’s bad prognosis is primarily due to intra-tumor heterogeneity, demonstrated from several studies that collected molecular biology, cytogenetic data and more recently radiomic features for a better prognostic stratification. The GLIFA project (GLIoblastoma Feature Analysis) is a multicentric project planned to investigate the role of radiomic analysis in GB management, to verify if radiomic features in the tissue around the resection cavity may guide the radiation target volume delineation.Materials and methodsWe retrospectively analyze from three centers radiomic features extracted from 90 patients with total or near total resection, who completed the standard adjuvant treatment and for whom we had post-operative images available for features extraction. The Manual segmentation was performed on post gadolinium T1w MRI sequence by 2 radiation oncologists and reviewed by a neuroradiologist, both with at least 10 years of experience. The Regions of interest (ROI) considered for the analysis were: the surgical cavity ± post-surgical residual mass (CTV_cavity); the CTV a margin of 1.5 cm added to CTV_cavity and the volume resulting from subtracting the CTV_cavity from the CTV was defined as CTV_Ring. Radiomic analysis and modeling were conducted in RStudio. Z-score normalization was applied to each radiomic feature. A radiomic model was generated using features extracted from the Ring to perform a binary classification and predict the PFS at 6 months. A 3-fold cross-validation repeated five times was implemented for internal validation of the model.ResultsTwo-hundred and seventy ROIs were contoured. The proposed radiomic model was given by the best fitting logistic regression model, and included the following 3 features: F_cm_merged.contrast, F_cm_merged.info.corr.2, F_rlm_merged.rlnu. A good agreement between model predicted probabilities and observed outcome probabilities was obtained (p-value of 0.49 by Hosmer and Lemeshow statistical test). The ROC curve of the model reported an AUC of 0.78 (95% CI: 0.68–0.88).ConclusionThis is the first hypothesis-generating study which applies a radiomic analysis focusing on healthy tissue ring around the surgical cavity on post-operative MRI. This study provides a preliminary model for a decision support tool for a customization of the radiation target volume in GB patients in order to achieve a margin reduction strategy.