The absence of information regarding the 3D composition of pathology specimens is a challenge to many aspects of surgery, which now must rely solely on the 2D information on a small sample of the tissue visible on a microscope slide. The clinical need is well illustrated by imprecision in breast conserving surgery (BCS), which results in high national average rates of re-operative intervention due to close positive resection margins. Internationally, reoperative intervention for failed BCS ranges between 9% to 36%(1,2). Reoperative intervention increases the risk of perioperative complications, delays adjuvant therapy and imposes a substantial economic burden on patients and providers (3,4).
Intraoperative margin detection systems may improve precision of oncological margin control and thereby reduce re-operative intervention. Conventional techniques such as frozen section analysis and cytology are both labour intensive and time-consuming and therefore cannot be realistic deployed in most Centres. Specimen imaging techniques offer an alternative, permitting real-time assessment of tissue during surgery to confirm positive margins. Several modalities have been explored in the literature, including conventional X-ray, micro-CT, Digital Breast Tomosynthesis (DBT), micro MRI, and PET scans(5–8). Many of these systems have reached a critical stage of development with clinical data now emerging on diagnostic accuracy for intra-operative resection margin evaluation.

Our goal is to create a special edition comprising approximately 10-15 papers, each dedicated to the exploration of a given emerging imaging modality for improved precision in breast conserving surgery. Each paper will adopt the format of a clinical or systematic review and/or meta-analysis, delving into the existing evidence within the field. Where a individual group are the only team with clinical data, the paper will be a summary of their experience to date. For each imaging modality, our aim is to engage pioneers and experts from clinical, engineering and industrial/commercial sectors. The development of this special edition will consolidate the latest information, establishing a landmark resource for clinicians to reference when delving into these imaging modalities. Subsequently, this initiative will empower clinicians in the field to publish additional prospective or retrospective studies, case reviews, and case reports as the technology continues to advance.

The scope of this special edition is to focus exclusively on emerging imaging technologies employed for intraoperative assessment of oncological margin status in breast-conserving surgery. Our aim is to analyze these technologies, assess their diagnostic accuracy in comparison against gold standard histology and other currently used modalities, and explore their applicability from the perspectives of both clinicians and industry experts.

The following is the scope in which papers are to be created- in no particular order

1. Brief Overview of Clinical Challenges and Emerging Technology for Precision Breast Surgery
Lead: Daniel Richard Leff (Reader in Breast Surgery working in the Departments of BioSurgery and Surgical Technology and Hamlyn Centre for Robotic Surgery at Imperial College London)

2. Specimen Tomography
Lead: Dr Andrea Colton (Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern, USA) .Paul Thiruchelvam, Consultant Breast Surgeon, Imperial College Healthcare NHS

3. Micro CT Analysis of Medical Specimens: Anatomical, Economic, Operational, and Patient-Outcome Aspects.
Lead: James Michaelson (Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, USA)
Industry partners: CLARIX

4. Phase Contrast CT
Lead: Sandro Olivo (Professor In Applied Physics Dept of Med Phys & Biomedical Eng, University College London, UK)

5. Micro MRI
Lead: Mellisa A Mallory (Moffitt Cancer Treatment, Tampa, Florida)

6. Cerenkov Luminescence Imaging
Lead: Professor Arnie Purusthotham (Professor of Breast Cancer at King’s College London and Consultant Surgeon at Guy’s and St Thomas NHS Foundation Trust, UK),

7. Optical Coherence Tomography
Lead: Professor Alistair Thompson (Co-Director, Lester and Sue Smith Breast Center, Section Chief, Breast Surgery at Baylor College of Medicine, Houston, Texas, USA)

8. Micro-Confocal Endoscopy
Lead: Daniel Richard Leff (Reader in Breast Surgery working in the Departments of BioSurgery and Surgical Technology and Hamlyn Centre for Robotic Surgery at Imperial College London)

9. Challenges of Emerging Imaging Technologies
Lead: James Michaelson (Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, USA) and Daniel R Leff (Reader in Breast Surgery working in the Departments of BioSurgery and Surgical Technology and Hamlyn Centre for Robotic Surgery at Imperial College London)

Submit your idea

Impact

Frontiers in Medical Engineering

Submit your idea

Impact