Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Int J Comput Assist Radiol Surg. 2018 Apr;13(4):531-539. doi: 10.1007/s11548-017-1684-4. Epub 2017 Nov 13.
PURPOSE: To evaluate a novel surgical navigation system for breast conserving surgery (BCS), based on real-time tumor tracking using the Calypso[Formula: see text] 4D Localization System (Varian Medical Systems Inc., USA). Navigation-guided breast conserving surgery (Nav-BCS) was compared to conventional iodine seed-guided BCS ([Formula: see text]I-BCS). METHODS: Two breast phantom types were produced, containing spherical and complex tumors in which wireless transponders (Nav-BCS) or a iodine seed ([Formula: see text]I-BCS) were implanted. For navigation, orthogonal views and 3D volume renders of a CT of the phantom were shown, including a tumor segmentation and a predetermined resection margin. In the same views, a surgical pointer was tracked and visualized. [Formula: see text]I-BCS was performed according to standard protocol. Five surgical breast oncologists first performed a practice session with Nav-BCS, followed by two Nav-BCS and [Formula: see text]I-BCS sessions on spherical and complex tumors. Postoperative CT images of all resection specimens were registered to the preoperative CT. Main outcome measures were the minimum resection margin (in mm) and the excision times. RESULTS: The rate of incomplete tumor resections was 6.7% for Nav-BCS and 20% for [Formula: see text]I-BCS. The minimum resection margins on the spherical tumors were 3.0 ± 1.4 mm for Nav-BCS and 2.5 ± 1.6 mm for [Formula: see text]I-BCS (p = 0.63). For the complex tumors, these were 2.2 ± 1.1 mm (Nav-BCS) and 0.9 ± 2.4 mm ([Formula: see text]I-BCS) (p = 0.32). Mean excision times on spherical and complex tumors were 9.5 ± 2.7 min and 9.4 ± 2.6 min (Nav-BCS), compared to 5.8 ± 2.2 min and 4.7 ± 3.4 min ([Formula: see text]I-BCS, both (p < 0.05). CONCLUSIONS: The presented surgical navigation system improved the intra-operative awareness about tumor position and orientation, with the potential to improve surgical outcomes for non-palpable breast tumors. Results are positive, and participating surgeons were enthusiastic, but extended surgical experience on real breast tissue is required.
目的：评估一种基于实时肿瘤跟踪的新型保乳手术（BCS）导航系统，该系统使用 Calypso[Formula: see text]4D 定位系统（美国 Varian Medical Systems Inc.）。将导航引导的保乳手术（Nav-BCS）与传统的碘种子引导的保乳手术（[Formula: see text]I-BCS）进行比较。
方法：制作了两种乳腺体模，其中包含球形和复杂肿瘤，在这些肿瘤中植入了无线应答器（Nav-BCS）或碘种子 ([Formula: see text]I-BCS)。用于导航，显示了体模 CT 的正交视图和 3D 体积渲染图，包括肿瘤分割和预定的切除边界。在相同的视图中，跟踪和可视化手术指针。按照标准方案进行 [Formula: see text]I-BCS。五名乳腺肿瘤外科医生首先使用 Nav-BCS 进行了一次练习，然后在球形和复杂肿瘤上进行了两次 Nav-BCS 和 [Formula: see text]I-BCS 手术。所有切除标本的术后 CT 图像均与术前 CT 进行了配准。主要观察指标为最小切除边界（mm）和切除时间。
结果：Nav-BCS 的不完全肿瘤切除率为 6.7%，[Formula: see text]I-BCS 为 20%。球形肿瘤的最小切除边界分别为 3.0±1.4mm（Nav-BCS）和 2.5±1.6mm（[Formula: see text]I-BCS）（p=0.63）。对于复杂肿瘤，这些分别为 2.2±1.1mm（Nav-BCS）和 0.9±2.4mm（[Formula: see text]I-BCS）（p=0.32）。球形和复杂肿瘤的平均切除时间分别为 9.5±2.7 分钟和 9.4±2.6 分钟（Nav-BCS），而 5.8±2.2 分钟和 4.7±3.4 分钟 ([Formula: see text]I-BCS，均（p<0.05）。
结论：所提出的手术导航系统提高了对肿瘤位置和方向的术中认识，有可能改善非触诊性乳腺肿瘤的手术结果。结果是积极的，参与的外科医生很热情，但需要在实际的乳腺组织上进行更多的手术经验。
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