%0 Journal Article
%T Computerized Decision Support System for Intraoperative Analysis of Margin Status in Breast Conservation Therapy
%A Manuel E. Ruid赤az
%A Sarah L. Blair
%A Andrew C. Kummel
%A Jessica Wang-Rodriguez
%J ISRN Surgery
%D 2012
%R 10.5402/2012/546721
%X Background. Breast conservation therapy (BCT) is the standard treatment for breast cancer; however, 32每63% of procedures have a positive margin leading to secondary procedures. The standard of care to evaluate surgical margins is based on permanent section. Imprint cytology (IC) has been used to evaluate surgical samples but is limited by excessive cauterization thus requiring experienced cytopathologist for interpretation. An automated image screening process has been developed to detect cancerous cells from IC on cauterized margins. Methods. IC was prospectively performed on margins during lumpectomy operations for breast cancer in addition to permanent section on 127 patients. An 8-slide training subset and 8-slide testing subset were culled. H&E IC automated analysis, based on linear discriminant analysis, was compared to manual pathologist interpretation. Results. The most important descriptors, from highest to lowest performance, are nucleus color (23%), cytoplasm color (15%), shape (12%), grey intensity (9%), and local area (5%). There was 100% agreement between automated and manual interpretation of IC slides. Conclusion. Although limited by IC sampling variability, an automated system for accurate IC cancer cell identification system is demonstrated, with high correlation to manual analysis, even in the face of cauterization effects which supplement permanent section analysis. 1. Introduction Approximately 32每63% of breast conservation therapy surgeries result in positive margins [1]. To control local recurrence of disease, a negative margin status is required [2每5]. Therefore, a positive margin diagnosis may result in multiple reexcision surgeries, increased likelihood of complications, physical discomfort, emotional distress, and decreased cosmetic outcomes [1, 6]. Several techniques have been tested for the manual intraoperative evaluation of margins including gross examination [6每8], intraoperative ultrasound [8每12], frozen section analysis (FSA) [13每17], and imprint cytology (IC) [5, 18每21]. Herein we report on the feasibility of using automated IC analysis as a margin evaluation tool. IC is an alternative intraoperative technique to detect cancer cells at the margin surface. Following tumor excision, the sample surface is imprinted on glass slides while keeping track of the margin location [21, 22]. Cells on the margin surface are removed during imprinting by electrostatic and hydrophobic interactions with the glass slide which preferentially adsorbs epithelial and blood cells over adipose tissue [23]. The advantage of this technique is
%U http://www.hindawi.com/journals/isrn.surgery/2012/546721/