Abstract
Surgical resection remains the primary curative treatment for many early-stage cancers, including breast cancer. The development of intraoperative guidance systems for identifying all sites of disease and improving the likelihood of complete surgical resection is an area of active ongoing research, as this can lead to a decrease in the need of subsequent additional surgical procedures. We develop a wearable goggle navigation system for dual-mode optical and ultrasound imaging of suspicious lesions. The system consists of a light source module, a monochromatic CCD camera, an ultrasound system, a Google Glass, and a host computer. It is tested in tissue-simulating phantoms and an ex vivo human breast tissue model. Our experiments demonstrate that the surgical navigation system provides useful guidance for localization and core needle biopsy of simulated tumor within the tissue-simulating phantom, as well as a core needle biopsy and subsequent excision of Indocyanine Green (ICG)—fluorescing sentinel lymph nodes. Our experiments support the contention that this wearable goggle navigation system can be potentially very useful and fully integrated by the surgeon for optimizing many aspects of oncologic surgery. Further engineering optimization and additional in vivo clinical validation work is necessary before such a surgical navigation system can be fully realized in the everyday clinical setting.
Highlights
Surgical resection remains the primary curative treatment for many early-stage cancers, including breast cancer
Related to breast cancer, surgical resection margin positivity with breast conserving surgery has been reported in a wide range from 6% to 60%, with most series reporting in the range from 15% to 30% [3,4,5]
It is our belief that this Google Glass navigation system can be utilized and fully integrated by the surgeon into all aspects of oncologic surgery, including: (i) aiding in the complete resection of the primary tumor site(s)[30, 31], (ii) intraoperative identification of previously unrecognized multifocal disease or occult disease, (iii) intraoperative determination of completeness of surgical resection and (iv) determination of the final status of the surgical resection margins on the excised surgical specimen as well as within the resultant surgical excision cavity
Summary
Surgical resection remains the primary curative treatment for many early-stage cancers, including breast cancer. The major challenges facing surgeons in the operating room during cancer surgery are the correct identification of all sites of disease, the accomplishment of complete surgical resection, and accurate assessment of the surgical resection margins [1]. Permanent histopathologic analysis, using hematoxylin and eosin (H&E), remains the current gold standard for the microscopic assessment of surgical resection margins [6]. This process is labor-intensive, is not accomplished in real-time, and realistically only assesses a minute fraction of both the entire margin surface area and the entire 3-dimensional volume of the surgical resection specimen [7, 8]. The under-sampled surgical resection specimen leads to inaccuracies in determining the final status of the surgical resection margins, in assessing the extent of disease, and in detecting multifocal disease or occult disease[8]
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