Cattacin Irene, Rochat Timothée, Feki Anis, Fruscalzo Arrigo, Boulvain Michel, Guani Benedetta
University Hospital of Lausanne, CHUV, 1005 Lausanne, Switzerland.
University of Fribourg, 1700 Fribourg, Switzerland.
Cancers (Basel). 2025 Aug 30;17(17):2852. doi: 10.3390/cancers17172852.
Breast-conserving surgery (BCS) is recommended for early-stage breast cancer, with the aim of removing tumors while preserving breast tissue. Achieving clear margins is crucial to minimizing re-excision and recurrence risks. The Histolog Scanner (HS), a confocal laser microscopy device, enables real-time intraoperative margin assessments. This study describes surgeon training, HS integration into clinical practice, and its impact on surgical outcomes. One surgeon participated in an online training program related to Histolog image of breast tissue. We assessed the time and workload required for the surgeon's training, as well as the implementation of the HS into the surgical workflow. We retrospectively analyzed patients who underwent BCS with an intraoperative margin assessment performed by the trained surgeon using HS between December 2022 and January 2025. The re-excision rate was collected, and sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the final pathology assessment as the gold standard. The surgeon completed the online training in 6 h 22 min over six days. HS integration into the routine workflow occurred smoothly. Retrospective analysis included 68 consecutive patients representing two years of clinical practice. The surgeon using the HS exhibited a sensitivity of 100%, specificity of 96.3%, accuracy of 96.9%, PPV of 85.7%, and NPV of 100%. Intraoperative HS usage eliminated re-excision in all cases. Integrating the HS into routine BCS procedures provides a highly accurate intraoperative margin assessment and significant reduction of re-excision rates.
保乳手术（BCS）适用于早期乳腺癌，旨在切除肿瘤的同时保留乳腺组织。实现切缘阴性对于将再次切除和复发风险降至最低至关重要。组织学扫描仪（HS）是一种共聚焦激光显微镜设备，能够在术中进行实时切缘评估。本研究描述了外科医生培训、HS融入临床实践及其对手术结果的影响。一名外科医生参加了与乳腺组织组织学图像相关的在线培训项目。我们评估了外科医生培训所需的时间和工作量，以及HS在手术流程中的应用情况。我们回顾性分析了2022年12月至2025年1月期间由经过培训的外科医生使用HS进行术中切缘评估的保乳手术患者。收集再次切除率，并以最终病理评估作为金标准计算敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。该外科医生在六天内用6小时22分钟完成了在线培训。HS顺利融入常规工作流程。回顾性分析包括代表两年临床实践的68例连续患者。使用HS的外科医生的敏感性为100%，特异性为96.3%，准确性为96.9%，PPV为85.7%，NPV为100%。术中使用HS在所有病例中均避免了再次切除。将HS融入常规保乳手术程序可提供高度准确的术中切缘评估，并显著降低再次切除率。
