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Screening
may eventually reduce additional Breast
Surgery
Newswise — A team of researchers at the
University of California, San Diego (UCSD)
and the Moores UCSD Cancer Center have
developed a rapid, automated image screening
process to distinguish breast cancer cells
from normal cells.
The technique, which is based on the density
of cells seen on a microscope slide, may
eventually lead to better ways for surgeons
to determine if they have removed all of the
cancer during breast-conserving cancer
surgery and cut down on the number of needed
second operations.
One of the biggest dilemmas in
breast-conserving “lumpectomies” is whether
or not all of the cancer has been removed.
To find out, pathologists examine the
tissue, looking for cancer cells from the
outer margins.
But this process is slow,
taking up to a week. All too often – between
20 and 50 percent of the time – some disease
remains, meaning more surgery.
“The majority of women are good candidates
for breast conservation surgery,” said
breast surgeon Sarah Blair, MD, associate
clinical professor of surgery at the UC San
Diego School of Medicine, who led the work.
“The problem is getting negative margins –
meaning the edge of what we remove has no
cancer – the first time we operate because
we are dealing sometimes with small tumors
that can be difficult to see or feel.
"Right
now there is no good way during the
operation to make sure that we have removed
every cancer cell.
"We’d like to reduce the
need for second operations, which will spare
the patient the trauma of surgery again and
reduce costs.”
Reporting in the Annals of Surgical
Oncology, Blair and her co-workers examined
samples of normal breast tissue from 10
women and tumor samples from 24 women with
cancer.
They showed that a technique called
automated microscopy, with the help of
specially designed computer software, could
correctly identify invasive breast cancer
cells in 83 percent of the tumor specimens,
whereas a normal microscope only identified
cancer in 65 percent of the cancer
specimens.
The researchers used a method called “touch
prep” to collect the cancer cells for
evaluation, which entails gathering cells to
be stained and then examined and which
normally requires a specialized pathologist
to subjectively interpret.
But in this case,
the scientists used the center of the tumor,
rather than the outer tissue edges, where it
is more difficult to identify cancer cells,
to confirm that the technique actually
worked.
“We compared manual microscopy, looking at
the tissue cells on a slide under the
microscope, with automated programs, in
which we taught a computer how to look at
the slides with a microscope, and they
correlated pretty well,” Blair said.
A
camera connected to the microscope takes
photos of the slide, which are then analyzed
for cancer.
“We thought that if we automated
it, we could teach the computer what to look
for and have the pathologist quickly
correlate the computer findings with their
findings.
"We’re hoping that the method makes
the process more objective.”
According to Blair, the automated technique
is still too slow to be used in real time
during breast surgery.
Each slide of breast
tissue cells takes about two hours to be
analyzed, she said, and six slides are
typically examined during breast
conservation surgery.
They would like to
reduce the analysis time to as little as
five minutes per slide, and based on the
results, know whether or not the patient
needs further surgery while she is still in
the operating room.
As the researchers continue to refine the
technique, they will be able to eventually
test its use in examining breast tissue
margins.
Because it is difficult to identify preinvasive cancer cells, she said, they
also want to look at cell surface markers
and cell nucleus characteristics to better
identify cancer cells and help speed up the
identification process.
The findings are
still preliminary, and Blair and her
co-workers are planning to conduct a larger,
multicenter trial of the automated
technique.
Other UCSD coauthors on the paper include
Maria Jose Cortes-Mateos, PhD, David Martin,
Sergio Sandoval, Manuel E. Ruidiaz, Davorka
Messmer, PhD, Jessica Wang-Rodriguez, MD,
William Trogler, PhD and Andrew C. Kummel,
PhD.
Established in 1965, the Department of
Surgery at UC San Diego Medical Center
represents more than 80 leading surgeons
with specialties in open, minimally invasive
and scarless surgery techniques.
The
Department is committed to advancing
surgical education by teaching and training
the next generation of innovators;
researching, testing and developing
groundbreaking surgical techniques;
providing superior patient care and service;
and attracting a world-class faculty.
The Moores UCSD Cancer Center is one of the
nation’s 41 National Cancer
Institute-designated Comprehensive Cancer
Centers, combining research, clinical care
and community outreach to advance the
prevention, treatment and cure of cancer.
For more information, visit
www.cancer.ucsd.edu.
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