Performance of a novel protease-activated fluorescent imaging system for intraoperative detection of residual breast cancer during breast conserving surgery.
Performance of a novel protease-activated fluorescent imaging system for intraoperative detection of residual breast cancer during breast conserving surgery.
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DOI：
10.1007/s10549-021-06106-w
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发表时间：
2021-05
影响因子：
3.8
通讯作者：
Smith BL
中科院分区：
文献类型：
--
作者：
Lanahan CR;Kelly BN;Gadd MA;Specht MC;Brown CL;Hughes KS;Tang R;Rai U;Brachtel EF;Rice-Stitt T;Smith BL
安全的乳腺癌肿块切除术需要显微镜下清晰的边缘。实时切缘评估的选择是有限的，20-40%的肿块切除术有阳性切缘，需要再次切除。LUM成像系统之前在乳房肿瘤切除术中显示出出色的肿瘤检测灵敏度和特异性。我们探讨了其对手术工作流程和患者和肿瘤类型性能的影响。我们对乳腺癌肿块切除术进行了IRB批准的前瞻性非随机研究。LUM成像系统使用LUM 015，这是一种蛋白酶激活的荧光成像剂，可识别手术腔壁中的残留肿瘤。实时收集荧光腔图像并使用系统软件进行分析。在注射0.5或1.0 mg/kg LUM 015的55名患者和未接受LUM 015的5名患者中获得腔和标本图像。所有肿瘤类型均与正常组织相区别，平均肿瘤：正常（T：N）信号比为3.81-5.69。T：N比值在非致密乳腺中为4.45，在致密乳腺中为4.00（p = 0.59），在绝经前女性中为3.52，在绝经后女性中为4.59（p = 0.19）。组织学和肿瘤受体检测不受LUM 015的影响。当肿瘤距离相邻标本边缘< 2 mm时，假阳性读数更有可能。LUM 015信号在体内注射后至少6.5小时稳定，并且离体切除后至少4小时稳定。术中使用LUM成像系统可检测所有乳腺癌亚型，性能稳健，与绝经状态和乳腺密度无关。对组织病理学或受体评价无显著影响。
Safe breast cancer lumpectomies require microscopically clear margins. Real-time margin assessment options are limited, and 20–40% of lumpectomies have positive margins requiring re-excision. The LUM Imaging System previously showed excellent sensitivity and specificity for tumor detection during lumpectomy surgery. We explored its impact on surgical workflow and performance across patient and tumor types. We performed IRB-approved, prospective, non-randomized studies in breast cancer lumpectomy procedures. The LUM Imaging System uses LUM015, a protease-activated fluorescent imaging agent that identifies residual tumor in the surgical cavity walls. Fluorescent cavity images were collected in real-time and analyzed using system software. Cavity and specimen images were obtained in 55 patients injected with LUM015 at 0.5 or 1.0 mg/kg and in 5 patients who did not receive LUM015. All tumor types were distinguished from normal tissue, with mean tumor:normal (T:N) signal ratios of 3.81–5.69. T:N ratios were 4.45 in non-dense and 4.00 in dense breasts (p = 0.59) and 3.52 in premenopausal and 4.59 in postmenopausal women (p = 0.19). Histopathology and tumor receptor testing were not affected by LUM015. Falsely positive readings were more likely when tumor was present < 2 mm from the adjacent specimen margin. LUM015 signal was stable in vivo at least 6.5 h post injection, and ex vivo at least 4 h post excision. Intraoperative use of the LUM Imaging System detected all breast cancer subtypes with robust performance independent of menopausal status and breast density. There was no significant impact on histopathology or receptor evaluation.
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DOI：
10.1056/nejmoa1504473
发表时间：
2015-08-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Chagpar AB;Killelea BK;Tsangaris TN;Butler M;Stavris K;Li F;Yao X;Bossuyt V;Harigopal M;Lannin DR;Pusztai L;Horowitz NR
通讯作者：
Horowitz NR
DOI：
10.1016/j.ijrobp.2013.11.012
发表时间：
2014-03-01
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
Moran MS;Schnitt SJ;Giuliano AE;Harris JR;Khan SA;Horton J;Klimberg S;Chavez-MacGregor M;Freedman G;Houssami N;Johnson PL;Morrow M
通讯作者：
Morrow M
影响因子：
45.3
作者：
Allison, Kimberly H.;Hammond, M. Elizabeth H.;Wolff, Antonio C.
通讯作者：
Wolff, Antonio C.
影响因子：
3.7
作者：
Coopey, Suzanne B.;Buckley, Julliette M.;Specht, Michelle C.
通讯作者：
Specht, Michelle C.
影响因子：
3.7
作者：
Wang K;Ren Y;He J
通讯作者：
He J