Abstract
In breast surgery, a lack of knowledge about what is below the tissue surface may lead to positive tumor margins and iatrogenic damage. Diffuse reflectance spectroscopy (DRS) is a spectroscopic technique that can distinguish between healthy and tumor tissue making it a suitable technology for intraoperative guidance. However, because tumor surgeries are often performed with an electrosurgical knife, the effect of a coagulated tissue layer on DRS measurements must be taken into account. It is evaluated whether real-time DRS measurements obtained with a photonic electrosurgical knife could provide useful information of tissue properties also when tissue is coagulated and cut. The size of the coagulated area is determined and the effect of its presence on DR spectra is studied using ex vivo porcine adipose and muscle tissue. A coagulated tissue layer with a depth of 0.1 to 0.4mm is observed after coagulating muscle with an electrosurgical knife. The results show that the effect of coagulating adipose tissue is negligible. Using the fat/water ratio's calculated from the measured spectra of the photonic electrosurgical knife, it was possible to determine the distance from the instrument tip to a tissue transition during cutting. In conclusion, the photonic electrosurgical knife can determine tissue properties of coagulated and cut tissue and has, therefore, the potential to provide real-time feedback about the presence of breast tumor margins during cutting, helping surgeons to establish negative margins and improve patient outcome.
Highlights
Breast cancer is expected to affect one in eight women during their lifetime,[1] making it a major global health threat
Kobbermann et al.[11] found that 31.9% of the patients who had a partial mastectomy required repeat surgery. These rates indicate that positive margins in breast cancer surgery are a wide-spread problem that leads to high costs and negative patient outcomes
The coagulation zone is invisible for both cutting and coagulation of adipose tissue
Summary
Breast cancer is expected to affect one in eight women during their lifetime,[1] making it a major global health threat. A negative margin means that the excised tumor is completely surrounded by a small layer of healthy tissue, leaving no tumor cells behind in the body.[2] Positive margins create higher chances of local recurrence, a decreased likelihood of overall survival, and require additional treatments such as reexcision surgery, extra radiation therapy, and chemotherapy.[5,6,7,8,9] Tartter et al.[10] found positive margin prevalence rates ranging from 31% to 46% for ductal carcinoma in situ (DCIS) alone and 11% to 46% for invasive breast cancers and DCIS combined. Kobbermann et al.[11] found that 31.9% of the patients who had a partial mastectomy required repeat surgery These rates indicate that positive margins in breast cancer surgery are a wide-spread problem that leads to high costs and negative patient outcomes
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