Abstract
Simple SummaryBreast cancer is the most diagnosed cancer for women, and clear surgical margins in breast-conserving surgery (BCS) are essential for preventing recurrence. In this study, the potential of fast field-cycling 1H-NMR relaxometry as a new tool for intraoperative margin assessment was evaluated. The technique allows the determination of the tissue proton relaxation rates as a function of the applied magnetic field on small tissue samples excised from surgical specimens, at the margins of tumour resection, prior to histopathological analysis. It was found that a good accuracy in margin assessment, i.e., a sensitivity of 92% and a specificity of 85%, can be achieved. The discriminating ability shown by the relaxometric assay relies mainly on the difference of fat/water content between healthy and tumour cells. The information obtained has the potential to support the surgeon in real-time margin assessment during BCS.As conserving surgery is routinely applied for the treatment of early-stage breast cancer, the need for new technology to improve intraoperative margin assessment has become increasingly important. In this study, the potential of fast field-cycling 1H-NMR relaxometry as a new diagnostic tool was evaluated. The technique allows the determination of the tissue proton relaxation rates (R1), as a function of the applied magnetic field, which are affected by the changes in the composition of the mammary gland tissue occurring during the development of neoplasia. The study involved 104 small tissue samples obtained from surgical specimens destined for histopathology. It was found that a good accuracy in margin assessment, i.e., a sensitivity of 92% and a specificity of 85%, can be achieved by using two quantifiers, namely (i) the slope of the line joining the R1 values measured at 0.02 and 1 MHz and (ii) the sum of the R1 values measured at 0.39 and 1 MHz. The method is fast, and it does not rely on the expertise of a pathologist or cytologist. The obtained results suggest that a simplified, low-cost, automated instrument might compete well with the currently available tools in margin assessment.
Highlights
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death for women worldwide [1]
Numerous trials have demonstrated equivalent survival outcomes for mastectomy and for breast-conserving therapy if clear margins are maintained during the surgery [3]
It is evident that a clinical need exists calling for methods able to support the surgeon’s decisions on the identification of tumour margins during breast-conserving surgery (BCS)
Summary
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death for women worldwide [1]. The recommended treatment for early-stage disease is breast-conserving surgery (BCS) [2] This procedure seeks to remove cancer, leaving a margin of healthy tissue surrounding the excised specimen while providing a satisfactory cosmetic outcome. A return to the surgery room for margin re-excision results in additional anxiety for patients; delays in the onset of adjuvant therapy; additional exposure to the risks of anaesthesia; increased surgical complications, including increased surgical site infections; lower patient satisfaction; lower rates of cosmetic acceptability; increased health care costs; and even increased probability to go for bilateral mastectomies [6,7,8] On this basis, it is evident that a clinical need exists calling for methods able to support the surgeon’s decisions on the identification of tumour margins during BCS. The information obtained has the potential to support the surgeon in real-time margin assessment during breast-conserving surgery
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