Intraoperative tumor margin assessment using diffuse reflectance spectroscopy: the effect of electrosurgery on tissue discrimination using ex vivo animal tissue models.

Sara Azizian Amiri,Jenny Dankelman,Benno H. W. Hendriks,Carlijn M. Van Gent

doi:10.1364/boe.385621

Abstract

Using an intraoperative margin assessment technique during breast-conserving surgery (BCS) helps surgeons to decrease the risk of positive margin occurrence. Diffuse reflectance spectroscopy (DRS) has the potential to discriminate healthy breast tissue from cancerous tissue. We investigated the performance of an electrosurgical knife integrated with a DRS on porcine muscle and adipose tissue. Characterization of the formed debris on the optical fibers after electrosurgery revealed that the contamination is mostly burned tissue. Even with contaminated optical fibers, both tissues could still be discriminated with DRS based on fat/water ratio. Therefore, an electrosurgical knife integrated with DRS may be a promising technology to provide the surgeon with real-time guidance during BCS.

Highlights

Breast cancer is the most common cancer among women worldwide and the incidence keeps increasing [1]
We investigated the possibility of integrating a Diffuse reflectance spectroscopy (DRS) system into the electrosurgical knife to investigate whether it would be possible to provide the surgeon with an intraoperative tumor margin assessment
We investigated the effect of electrosurgery on the performance of the diffused reflectance spectroscopy system integrated into the tip of the electrosurgical knife

Summary

Introduction

Breast cancer is the most common cancer among women worldwide and the incidence keeps increasing [1]. It has been shown that lack of direct view over the surgical site or surgeon’s failure to determine the exact position of the tumor based on preoperative images may lead to incomplete resection of the tumor and incidence of positive margin [3]. Positive margins occur when the excised tumor is not surrounded by at least 2 mm of healthy tissue. The incidence of positive margin during tumor surgery is a widespread problem in clinical practice, but no standard solution has been developed yet [4]. In the case of positive margin detection, re-excision surgery or extra radiation therapy and chemotherapy are required [5,6,7]. The occurrence rate for re-excision surgery ranges from less than 10% to around 50% [8]

Methods

Results

Discussion

Conclusion