Abstract
Clean surgical margins in breast‐conserving surgery (BCS) are essential for preventing recurrence. Intraoperative pathologic diagnostic methods, such as frozen section analysis and imprint cytology, have been recognized as crucial tools in BCS. However, the complexity and time‐consuming nature of these pathologic procedures still inhibit their broader applicability worldwide. To address this situation, two issues should be considered: 1) the development of nonpathologic intraoperative diagnosis methods that have better sensitivity, specificity, speed, and cost; and 2) the promotion of new imaging algorithms to standardize data for analyzing positive margins, as represented by artificial intelligence (AI), without the need for judgment by well‐trained pathologists. Researchers have attempted to develop new methods or techniques; several have recently emerged for real‐time intraoperative management of breast margins in live tissues. These methods include conventional imaging, spectroscopy, tomography, magnetic resonance imaging, microscopy, fluorescent probes, and multimodal imaging techniques. This work summarizes the traditional pathologic and newly developed techniques and discusses the advantages and disadvantages of each method. Taking into consideration the recent advances in analyzing pathologic data from breast cancer tissue with AI, the combined use of new technologies with AI algorithms is proposed, and future directions for real‐time intraoperative margin assessment in BCS are discussed.
Highlights
Clean surgical margins in breast-conserving surgery (BCS) are essential breast-conserving surgery (BCS) is the standard therapy
BCS has been used as the primary treatment for early-stage breast cancer, more accurate techniques are needed to assess resection margins during surgery to avoid the need for re-excision and reoperation
Wang and co-workers developed PAM, which was combined with UV laser illumination.[14b]. The advantage of UV laser illumination is that it could highlight the nuclei so that their PAM technique could provide images similar to those obtained with hematoxylin and eosin (H&E) staining, a conventional and reliable method used for real-time intraoperative margin assessment in BCS
Summary
Frozen section analysis and imprint cytology are the traditional pathologic methods for real-time intraoperative margin assessment in BCS.[5]. Pradipta received his Ph.D. in 2011 from Osaka University under the direction of Professor Koichi Fukase and Professor Yukari Fujimoto. He worked as a postdoctoral researcher at Osaka University and RIKEN. Tomonori Tanei began his medical career in 1999 when he graduated from Fukuoka University Medical School and worked as a resident physician from 1999 to 2006 in various hospitals He conducted cancer research focused on breast cancer stem cells for his Ph.D. at Osaka University, before he moved to the Houston Methodist Research Institute as a postdoctoral fellow in 2011.
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