术中三维超声系统在乳腺癌手术中用于肿瘤边界的确定。

An intraoperative 3D ultrasound system for tumor margin determination in breast cancer surgery.

机构信息

Imaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5K8, Canada.

出版信息

Med Phys. 2010 Feb;37(2):564-70. doi: 10.1118/1.3290867.

DOI:10.1118/1.3290867

PMID:20229864

Abstract

PURPOSE

The purpose of this study was to analyze the clinical utility of a portable three-dimensional ultrasound (3DUS) system to be used for surgical guidance of lumpectomy surgeries. In 11%-60% of lumpectomy surgeries, a second surgery is required to fully resect the tumor. Previous studies have used 3DUS as a guidance tool with the hope of more accuracy in resecting the entire tumor during the first surgery. However, they utilized larger systems, which are not easily integrated into the operating room.

METHODS

The portable 3DUS scanning system we developed consisted of a motorized "tilt" scanner coupled to a Terason t3000 portable ultrasound machine (Terason Ultrasound, Burlington, MA). The 3DUS system was evaluated by measuring agar "tumor" phantoms of known volumes and acquiring and segmenting images from nine patients undergoing lumpectomy.

RESULTS

Experiments on simulated agar tumor phantoms have shown that our device could be used to measure objects with smooth, well-defined boundaries of known volume with an error of 3%. It was possible to view and segment estimated tumor margins from the clinical images in three dimensions. Correspondence between measurements obtained in the laboratory and the operating room varied with tumor geometry and the degree of spiculation in the ultrasound image. The measured values obtained by the system did not correspond closely with those obtained using histology. However, a more accurate histological measurement using 3D histology may provide a better basis for comparison.

CONCLUSIONS

The results of imaging simulated agar tumor phantoms indicate the system's consistency in measuring objects of known volume and geometry. The system could be used for segmenting the approximate boundary of lumpectomy patients' breast tumors relative to inserted guide wires. The potential advantages of this system are a reduction in the number of re-excision surgeries required and a reduction in the operative time with the patient under anesthesia.

摘要

目的

本研究旨在分析便携式三维超声（3DUS）系统在乳房肿瘤切除术手术中的临床应用。在 11%至 60%的乳房肿瘤切除术手术中，需要进行第二次手术以完全切除肿瘤。先前的研究使用 3DUS 作为一种指导工具，希望在第一次手术中更准确地切除整个肿瘤。然而，它们使用的系统较大，不易集成到手术室中。

方法

我们开发的便携式 3DUS 扫描系统由一个电动“倾斜”扫描仪与 Terason t3000 便携式超声机（Terason Ultrasound，Burlington，MA）耦合组成。通过测量具有已知体积的琼脂“肿瘤”体模并获取和分割九名接受乳房肿瘤切除术的患者的图像来评估 3DUS 系统。

结果

在模拟琼脂肿瘤体模的实验中，我们的设备可以用于测量具有已知体积的具有平滑、清晰边界的物体，误差为 3%。可以从三维视图中查看和分割临床图像中的估计肿瘤边界。在实验室和手术室中获得的测量值与肿瘤几何形状和超声图像中的刺状程度有关。系统获得的测量值与组织学测量值并不完全吻合。然而，使用 3D 组织学进行更准确的组织学测量可能会提供更好的比较基础。