Intraoperative Localization Of Lesions Research Articles

Radar localization of breast and axillary lesions with SCOUT: a prospective single institution pilot study.

Wire-guided localization has been the mainstay of localization techniques for non-palpable breast and axillary lesions prior to excision. Evidence is still growing for relatively newer localization technologies. This study evaluated the efficacy of the wireless localization technology, SCOUT®, for both breast and axillary surgery. Data were extracted from a prospective database (2021-2023) of consecutive patients undergoing wide local excision, excisional biopsy, targeted axillary dissection, or axillary lymph node dissection with SCOUT at a high-volume tertiary centre. Rates of successful reflector placement, intraoperative lesion localization, and reflector retrieval were evaluated. A survey of surgeon-reported ease of lesion localization and reflector retrieval was also evaluated. ACTRN386751. One-hundred-ninety-five reflectors were deployed in 172 patients. Median interval between deployment and surgery was 3 days (range 1-20) and mean distance from reflector to lesion was 3.2 mm (standard deviation, SD 3.1). Rate of successful localization and reflector retrieval was 100% for both breast and axillary procedures. Mean operating time was 65.8 min (SD 33). None of the reflectors migrated. No reflector deployment or localization-related complications occurred. Ninety-eight percent of surgeons were satisfied with ease of localization for the first half of cases. SCOUT is an accurate and reliable method to localize and excise both breast and axillary lesions, and it may overcome some of the limitations of wire-guided localization.

Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series

BackgroundVideo-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localization of lung nodules for VATS wedge resections, including our novel workflow using the hybrid OR cone-beam CT to re-evaluate patients who have undergone pre-operative localization for those who are unsuitable for intra-operative localization.MethodsRetrospective analysis of all consecutive patients with small (≤ 20 mm), deep (≥ 10 mm distance from pleura) and/or predominantly ground-glass nodules selected for lesion localization in the Interventional Radiology suite followed by re-evaluation with cone-beam CT in the hybrid OR (pre-operative), or in the hybrid OR alone (intra-operative), prior to intentional VATS wedge performed by a single surgeon at our centre from January 2017 to December 2021.Results30 patients with 36 nodules underwent localization. All nodules were successfully resected with a VATS wedge resection, although 10% of localizations had hookwire or coil dislodgement. The median effective radiation dose in the pre-operative group was 10.4 mSV including a median additional radiation exposure of 0.9 mSV in the hybrid OR for reconfirmation of hookwire or coil position prior to surgery (p = 0.87). The median effective radiation dose in the intra-operative group was 3.2 mSV with a higher mean rank than the intra-operative group, suggesting a higher radiation dose (p = 0.01).ConclusionsWe demonstrate that our multidisciplinary approach utilizing the hybrid OR is safe and effective. Intra-operative localization is associated with lower radiation doses. Routine use of cone-beam CT to confirm the position of the physical marker prior to surgery in the hybrid OR helps mitigate consequences of localization failure with only a modest increase in radiation exposure.

Patient with multifocal pancreatic insulinoma: a rare presentation of functional pancreatic neuroendocrine neoplasm

Insulinoma is a type of neuroendocrine tumour with an incidence of 1—4 cases per million. Multiple insulinomas constitute less than 10% of all insulinomas. Surgery is the treatment of choice for insulinoma. The operation can be done with an open or laparoscopic approach, with cure rates ranging from 77% to 100%. Pancreatic resection is recommended for tumours larger than 2 cm in size, while enucleation is advised for lesions smaller than 2cm if the tumour is at least 2—3 mm away from the main pancreatic duct to prevent the formation of a fistula. For better intraoperative localization of lesions, bimanual palpation together with intraoperative ultrasonography (IOUS) is advised. Palpation alone has 70% sensitivity, but together with IOUS, it reaches 85—95%
 A young female patient in her late 20s with non‑specific complaints and a medical history of epilepsy dating back to the age of 17 underwent a physical examination. Blood test results indicated severe hypoglycemia, and magnetic resonance imaging (MRI) revealed an 11‑mm neoplasia in the body of the pancreas. A 72‑hour fasting test confirmed the diagnosis of insulinoma, and the patient underwent laparoscopic surgery. IOUS was done for the precise localization of the lesion, and another tumour in the pancreatic tail was found. A spleen‑preserving laparoscopic distal pancreatectomy was performed. Histologic reports confirmed multifocal Grade 1 insulinoma. The postoperative course was uneventful. After 4 months of follow‑up, computed tomography (CT) was done, and there were no signs of recurrence of insulinoma, pancreatic pseudocysts, or other signs of postoperative complications. Since the operation, the patient has not had any episodes of hypoglycemia or seizures.
 The wide spectrum of symptoms, which are not specific to insulinomas, in particular seizures, can make it difficult to establish a correct diagnosis and can be mistaken for other psychiatric or neurologic disorders. This case clearly shows the advantages of IOUS‑guided surgery in achieving better visualization and outcomes. After enucleation of the smaller lesion without the use of IOUS, other insulinomas would be missed and left in place because they were located deeply in the parenchyma. Simple visualization and palpation would not be enough.

Short-term effectiveness of orthopedic robot-assisted resection for osteoid osteoma

To investigate short-term effectiveness and clinical application advantages of orthopedic robot-assisted resection for osteoid osteoma compared with traditional open surgery. A retrospective analysis was conducted on clinical data of 48 osteoid osteoma patients who met the selection criteria between July 2022 and April 2023. Among them, 23 patients underwent orthopedic robot-assisted resection (robot-assisted surgery group), and 25 patients received traditional open surgery (traditional surgery group). There was no significant difference ( P>0.05) in gender, age, disease duration, lesion location and size, and preoperative visual analogue scale (VAS) score, and musculoskeletal tumor society (MSTS) score between the two groups. The surgical time, intraoperative blood loss, intraoperative lesion localization time, initial localization success rate, infection, and recurrence were recorded and compared. VAS scores before surgery and at 24 hours, 1, 3, 6, and 9 months after surgery and MSTS score before surgery and at 3 months after surgery were assessed. All patients completed the surgery successfully, with no significant difference in surgical time between the two groups ( P>0.05). Compared to the traditional surgery group, the robot-assisted surgery group had less intraoperative blood loss, shorter lesion localization time, and shorter hospitalization time, with significant differences ( P<0.05). The initial localization success rate was higher in the robot-assisted surgery group than in the traditional surgery group, but the difference between the two groups was not significant ( P>0.05). All patients in both groups were followed up, with the follow-up time of 3-12 months in the robot-assisted surgery group (median, 6 months) and 3-14 months in the traditional surgery group (median, 6 months). The postoperative MSTS scores of both groups improved significantly when compared to those before surgery ( P<0.05), but there was no significant difference in the changes in MSTS scores between the two groups ( P>0.05). The postoperative VAS scores of both groups showed a gradually decreasing trend over time ( P<0.05), but there was no significant difference between the two groups after surgery ( P>0.05). During follow-up, except for 1 case of postoperative infection in the traditional surgery group, there was no infections or recurrences in other cases. There was no significant difference in the incidence of postoperative infection between the two groups ( P>0.05). Orthopedic robot-assisted osteoid osteoma resection achieves similar short-term effectiveness when compared to traditional open surgery, with shorter lesion localization time.

A multicenter prospective cohort study to evaluate feasibility of radio-frequency identification surgical guidance for nonpalpable breast lesions: design and rationale of the RFID Localizer 1 Trial

BackgroundBreast cancer screening and improving imaging techniques have led to an increase in the detection rate of early, nonpalpable breast cancers. For early breast cancer, breast conserving surgery is an effective and safe treatment. Accurate intraoperative lesion localization during breast conserving surgery is essential for adequate surgical margins while sparing surrounding healthy tissue to achieve optimal cosmesis. Preoperative wire localization and radioactive seed localization are accepted standard methods to guide surgical excision of nonpalpable breast lesions. However, these techniques present significant limitations. Radiofrequency identification (RFID) technology offers a new, nonradioactive method for localizing nonpalpable breast lesions in patients undergoing breast conserving surgery. This study aims to evaluate the feasibility of RFID surgical guidance for nonpalpable breast lesions.MethodsThis multicenter prospective cohort study was approved by the Institutional Review Board of the University Medical Center Utrecht. Written informed consent is obtained from all participants. Women with nonpalpable, histologically proven in situ or invasive breast cancer, who can undergo breast conserving surgery with RFID localization are considered eligible for participation. An RFID tag is placed under ultrasound guidance, up to 30 days preoperatively. The surgeon localizes the RFID tag with a radiofrequency reader that provides audible and visual real-time surgical guidance.The primary study outcome is the percentage of irradical excisions and reexcision rate, which will be compared to standards of the National Breast Cancer Organisation Netherlands (NABON)(≤ 15% irradical excisions of invasive carcinomas). Secondary outcomes include user acceptability/experiences, learning curve, duration and ease of the placement- and surgical procedure and adverse events.DiscussionThis study evaluates the feasibility of RFID surgical guidance for nonpalpable breast lesions. Results may have implications for the future localization techniques in women with nonpalpable breast cancer undergoing breast conserving surgery.Trial registrationNetherlands National Trial Register, NL8019, registered on September 12th 2019.

Feasibility of Radio-Guided Surgery for Neuroendocrine Tumours Using 99mTc-HYNIC TOC

Introduction and aim: Intra-operative localization of small functioning pancreatic neuroendocrine tumours and liver metastases can be challenging. We here demonstrate the feasibility, technical protocol, utility and safety aspect of intra-operative tumour localization in using 99mTc-HYNIC-TOC. Materials and methods: 6 patients diagnosed with GEP-NET with or without liver secondaries were included in this study (5 males, 1 female). 3 patients had primary NET of the pancreas of which 2 patients had in additional liver metastases, 1 patient had distal ileal NET with loco-regional nodes and liver metastases, 1 patient had primary nodal gastrinoma with no evidence of any pre-operative lesions in duodenum/pancreas, 1 patient had bilobar liver secondaries from metastatic rectal NET. All patients were injected with 925-1110 MBq of 99mTc-HYNIC-TOC IV and surgery was done after 18-20 hours later on day 2. Intra-operative tumour localization was done using a hand-held high sensitivity gamma probe. Results: Total 23 lesions were localised intra-operatively and confirmed on histopathological as NET. Of these, were 10 in the liver, 3 in pancreas, 9 in nodes and 1 in the distal ileum. Of these 23 lesions, 19 were localized pre-operatively on imaging and by non-aided visualization by surgeon and 4 lesions (17%) were exclusively seen on intra-op localization using probe. These included 2 nodes and 2 liver lesions, all of which measured less than 1cm. Conclusion: Radio-guided surgery gastro-entero-pancreatic neuroendocrine tumours using indigenous 99mTc-HYNIC-TOC is safe and feasible in clinical setting and promises to improve precision of intra-operative localization of lesions in liver and pancreas.

The Micromechanical Signature of Pituitary Adenomas: New Perspectives for the Diagnosis and Surgery

Pituitary adenomas are common tumors in the skull base that are associated with significant morbidity due to local compressive effects, hormonal hypersecretion, or treatment‐associated endocrine deficiency. Pituitary adenomas are often surgically resected to improve clinical symptoms, with the help of magnetic resonance imaging (MRI) to locate the tumor tissues. But still a large proportion of adenoma fail being located, being either too small or not dense enough. In addition, normal and tumor tissues do not always show optical contrast in endoscopic endonasal trans‐sphenoidal surgery. Finding new markers to delineate the tumor tissue has become mandatory to help the surgical procedure and limit relapses. Herein, an indentation‐type atomic force microscope is used to show that tumor tissues are two orders of magnitude softer than normal tissues, independent of the type of hormonal secretion. This softening correlates with the degradation of the reticulin, type IV collagen, and laminin scaffolds in all the tumors. This significant difference suggests that intraoperative lesion localization and margin assessment could be evaluated by an approach based on stiffness measurement.

550 Poster - Nonradioactive surgical guidance with radiofrequency identification technology for locating nonpalpable breast lesions; Initial experiences of the RFID Localizer I Trial

Background: In breast conserving surgery accurate intraoperative lesion localization is essential for adequate surgical margins while sparing surrounding healthy tissue to achieve optimal cosmesis. Radiofrequency identification (RFID) technology may offer a viable non-radioactive, non-wire alternative.

Heading toward radioactive seed localization in non-palpable breast cancer surgery? A meta-analysis.

Wire-guided localization is the most commonly used technique for intraoperative localization of non-palpable breast cancer. Radioactive seed localization (RSL) is becoming more popular and seems to be a reliable alternative for intraoperative lesion localization. The purpose of the present meta-analysis was to evaluate the use of RSL. Primary study outcomes were irradicality and re-excision rates. In total 3168 patients were included. The clinical adaptation shows growing confidence in RSL and further growth is expected.

Image-guided localization for video-assisted thoracic surgery.

Video-assisted thoracic surgery (VATS) has become a useful diagnostic and therapeutic tool in the management of lung, pleural, and mediatstinal disease. Preoperative image-guided localization is performed to aid the surgeon in the thoracoscopic resection of small lung lesions that would otherwise be difficult to resect. This article describes the techniques of localization and reviews our experience with this procedure. While the majority of localization procedures are performed during an immediately preoperative computed tomography (CT), the use of intraoperative lesion localization using an endosonographic probe has been reported. The need for localization before resection is dependent on the skill and experience of the thoracoscopist and the characteristics of the lung lesions.

Stereotactic transsylvian, transinsular approach for deep-seated lesions

Lesions located deep within the frontal and parietal lobes adjacent to the internal capsule are often considered surgically inaccessible. We have used intraoperative stereotactic lesion localization in conjunction with microsurgical dissection of the lateral sylvian fissure to accurately and atraumatically approach such lesions through the insular cortex. When possible, the sylvian fissure is widely opened using standard microsurgical technique. However, exploration through a precisely placed exposure no more than 1.0 cm in length is still feasible. Repeated intraoperative lesion localization employing ultrasound, frame-based or frameless stereotaxis was used to guide dissection deep to the Insular cortex. Using this approach we have resected five cavernous angiomas, three plexiform AVMs and 2 low-grade gliomas. There was a single case of transient dysphasia in seven dominant hemisphere explorations and a single case of transient somatosensory impairment. Otherwise, there were no new transient or permanent postoperative neurologic deficits. In two cases, hemiparesis present prior to surgery improved following resection of a cavernous angioma. The transsylvian, transinsular approach can be employed to safely expose lesions deep within the cerebral hemisphere. Anatomic considerations, surgical technical refinements, and clinical results are the subject of this report.