Margreet C. van der Schaaf

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Radiofrequency localization of nonpalpable breast cancer in a multicentre prospective cohort study: feasibility, clinical acceptability, and safety

Breast Cancer Research and Treatment (2023)

Anke Christenhusz Bianca M. den Dekker Thijs van Dalen Lisa M. Jongen Margreet C. van der Schaaf

Abstract Purpose In breast conserving surgery, accurate lesion localization is essential for obtaining adequate surgical margins. Preoperative wire localization (WL) and radioactive seed localization (RSL) are widely accepted methods to guide surgical excision of nonpalpable breast lesions but are limited by logistical challenges, migration issues, and legislative complexities. Radiofrequency identification (RFID) technology may offer a viable alternative. The purpose of this study was to evaluate the feasibility, clinical acceptability, and safety of RFID surgical guidance for localization of nonpalpable breast cancer. Methods In a prospective multicentre cohort study, the first 100 RFID localization procedures were included. The primary outcome was the percentage of clear resection margins and re-excision rate. Secondary outcomes included procedure details, user experience, learningcurve, and adverse events. Results Between April 2019 and May 2021, 100 women underwent RFID guided breast conserving surgery. Clear resection margins were obtained in 89 out of 96 included patients (92.7%), re-excision was indicated in three patients (3.1%). Radiologists reported difficulties with the placement of the RFID tag, partially related to the relatively large needle-applicator (12-gauge). This led to the premature termination of the study in the hospital using RSL as regular care. The radiologist experience was improved after a manufacturer modification of the needle-applicator. Surgical localization involved a low learning curve. Adverse events ( n = 33) included dislocation of the marker during insertion (8%) and hematomas (9%). The majority of adverse events (85%) occurred using the first-generation needle-applicator. Conclusion RFID technology is a potential alternative for non-radioactive and non-wire localization of nonpalpable breast lesions.

10.1007/s10549-023-07006-x

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Magnetic procedure for sentinel lymph node detection and evaluation of metastases: design and rationale of the Lowmag trial

Deleted Journal (2024)

Anke Christenhusz Anneriet E. Dassen Margreet C. van der Schaaf Sadaf Salamzadeh Mariël Brinkhuis

Abstract Background Primary tumour biology and axillary lymph node status are key prognostic factors in breast cancer treatment. The LowMag trial introduced a magnetic sentinel lymph node biopsy procedure using a superparamagnetic iron oxide (SPIO) tracer and a handheld magnetometer as a radiation-free alternative for axillary staging. The trial aimed to assess a low-dose magnetic tracer for non-invasive preoperative evaluation of lymph node metastases and intraoperative sentinel lymph node detection. Methods Patients with confirmed invasive breast cancer or ductal carcinoma in situ, eligible for sentinel lymph node biopsy, were included in the LowMag trial. The sentinel lymph nodes were detected perioperatively using Sentimag® and inked to maintain spatial orientation between MRI and histopathology. The amount of iron was estimated using two magnetic devices: SPaQ and Sentimag®. Additional ex vivo MRI was performed with a low-field MRI system. After being buffered in formalin, the sentinel lymph nodes were sectioned perpendicular to the MRI planes, consecutively sliced at 2 μm intervals, and stained with H&E, Perls Prussian blue, CK8/18, and CD68. Results In an interim assessment of 20 sentinel lymph nodes, two contained metastases. The analysis revealed good concordance in uptake between the magnetic and radioactive tracers, with a median iron content of 19.21 µg. In healthy sentinel lymph nodes, iron particles were found in both the subcapsular space and sinusoids, with macrophages nearby. Healthy regions within metastatic lymph nodes showed similar behaviour to healthy nodes. In metastatic sites, iron pigment presence was reduced, especially in areas occupied by tumour cells. A healthy lymph node with low iron content displayed a large central fatty region without iron uptake but confirmed iron in sinusoidal macrophages. The metastatic lymph node had subcapsular and parenchymal tumour cells in the central region, with limited infiltration into nearby adipose tissue and no local iron enhancement. However, iron deposits were detected within the sinusoids. Discussion The MRI images effectively distinguish between fat, nodal tissue, and the SPIO tracer, either through signal intensity or texture. This demonstrates the potential for sentinel lymph node imaging using a low-field MRI system.

10.1186/s44330-024-00006-3

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Magnetic procedure for sentinel lymph node detection and evaluation of metastases: Design and rationale of the Lowmag trial

Research Square (Research Square) (2023)

Anke Christenhusz Anneriet E. Dassen Margreet C. van der Schaaf Sadaf Salamzadeh Mariël Brinkhuis

Abstract Background Primary tumour biology and axillary lymph node status are crucial prognostic factors in breast cancer treatment. The LowMag trial introduced a magnetic sentinel lymph node biopsy (SLNB) procedure using a Superparamagnetic Iron Oxide (SPIO) tracer and handheld magnetometer as a radiation-free alternative for axillary staging. The objective of LowMag trial was to assess a low-dose magnetic tracer for non-invasive preoperative evaluation of lymph node metastases and intraoperative SLN detection. Methods Patients with confirmed invasive breast cancer or ductal carcinoma, eligible for SLNB, were included in the LowMag trial (NTR 4858, http://www.trialregister.nl) consisted of radioactive and magnetic SLNB. The SLNs were perioperatively detected by Sentimag®, and inked to keep track of spatial orientation between MRI and histopathology. Amount of iron was estimated post-surgery using two magnetic devices: SPaQ and Sentimag®. Additional ex vivo MRI was acquired using low-field MRI system (Pure Devices). After buffered in formalin fixation, the LN were lamellated perpendicular to the MRI planes, consecutively sectioned at 2 µm distance and stained with H&E, Perls Prussian blue, CK8/18 and CD68. Results In an interim assessment of 20 LNs (nine patients) two LNs from two patients contained a metastasis. The analysis reviled good uptake concordance between magnetic and radioactive tracer with median amount of iron trapped was 19.21 µg (ranging from 0.1 pg to 109 µg). Within healthy LNs, iron particles were observed in both the subcapsular space and sinusoids, with macrophages located in their proximity. Healthy regions within metastatic LNs exhibit a behaviour similar to that of the healthy LNs. In the metastatic sites, there was a reduced presence of iron pigment, particularly in the areas occupied by tumour cells. The healthy LN with low iron content shows a large fatty region in the centre of the node without iron uptake, and confirmed iron in the sinusoidal macrophages. The metastatic LN shows subcapsular and parenchymal tumour cells located in the central region, with limited infiltration into the nearby adipose tissue, without presence of local iron enhancement. However, iron deposits are were detected within the sinusoids. Conclusion The MRI images clearly differentiate between fat, nodal tissue and SPIO tracer (either in signal intensity or in texture), demonstrating a potential of LN imaging using a low-field MRI system.

10.21203/rs.3.rs-3750227/v1

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Breast MRI in patients after breast conserving surgery with sentinel node procedure using a superparamagnetic tracer

European Radiology Experimental (2022)

Anke Christenhusz Joost Pouw Frank F.J. Simonis Michael Douek Muneer Ahmed

Abstract Background A procedure for sentinel lymph node biopsy (SLNB) using superparamagnetic iron-oxide (SPIO) nanoparticles and intraoperative sentinel lymph node (SLN) detection was developed to overcome drawbacks associated with the current standard-of-care SLNB. However, residual SPIO nanoparticles can result in void artefacts at follow-up magnetic resonance imaging (MRI) scans. We present a grading protocol to quantitatively assess the severity of these artefacts and offer an option to minimise the impact of SPIO nanoparticles on diagnostic imaging. Methods Follow-up mammography and MRI of two patient groups after a magnetic SLNB were included in the study. They received a 2-mL subareolar dose of SPIO (high-dose, HD) or a 0.1-mL intratumoural dose of SPIO (low-dose, LD). Follow-up mammography and MRI after magnetic SLNB were acquired within 4 years after breast conserving surgery (BCS). Two radiologists with over 10-year experience in breast imaging assessed the images and analysed the void artefacts and their impact on diagnostic follow-up. Results A total of 19 patients were included (HD, n = 13; LD, n = 6). In the HD group, 9/13 patients displayed an artefact on T1-weighted images up to 3.6 years after the procedure, while no impact of the SPIO remnants was observed in the LD group. Conclusions SLNB using a 2-mL subareolar dose of magnetic tracer in patients undergoing BCS resulted in residual artefacts in the breast in the majority of patients, which may hamper follow-up MRI. This can be avoided by using a 0.1-mL intratumoural dose.

Breast-conserving surgery

Breast MRI

10.1186/s41747-021-00257-7

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Citations (21)

A multicenter prospective cohort study to evaluate feasibility of radio-frequency identification surgical guidance for nonpalpable breast lesions: design and rationale of the RFID Localizer 1 Trial

BMC Cancer (2022)

Bianca M. den Dekker Anke Christenhusz Thijs van Dalen Lisa M. Jongen Margreet C. van der Schaaf

Abstract Background Breast cancer screening and improving imaging techniques have led to an increase in the detection rate of early, nonpalpable breast cancers. For early breast cancer, breast conserving surgery is an effective and safe treatment. Accurate intraoperative lesion localization during breast conserving surgery is essential for adequate surgical margins while sparing surrounding healthy tissue to achieve optimal cosmesis. Preoperative wire localization and radioactive seed localization are accepted standard methods to guide surgical excision of nonpalpable breast lesions. However, these techniques present significant limitations. Radiofrequency identification (RFID) technology offers a new, nonradioactive method for localizing nonpalpable breast lesions in patients undergoing breast conserving surgery. This study aims to evaluate the feasibility of RFID surgical guidance for nonpalpable breast lesions. Methods This multicenter prospective cohort study was approved by the Institutional Review Board of the University Medical Center Utrecht. Written informed consent is obtained from all participants. Women with nonpalpable, histologically proven in situ or invasive breast cancer, who can undergo breast conserving surgery with RFID localization are considered eligible for participation. An RFID tag is placed under ultrasound guidance, up to 30 days preoperatively. The surgeon localizes the RFID tag with a radiofrequency reader that provides audible and visual real-time surgical guidance. The primary study outcome is the percentage of irradical excisions and reexcision rate, which will be compared to standards of the National Breast Cancer Organisation Netherlands (NABON)(≤ 15% irradical excisions of invasive carcinomas). Secondary outcomes include user acceptability/experiences, learning curve, duration and ease of the placement- and surgical procedure and adverse events. Discussion This study evaluates the feasibility of RFID surgical guidance for nonpalpable breast lesions. Results may have implications for the future localization techniques in women with nonpalpable breast cancer undergoing breast conserving surgery. Trial registration Netherlands National Trial Register, NL8019 , registered on September 12 th 2019.

Surgical oncology

Cosmesis

Breast-conserving surgery

Institutional review board

Lumpectomy

10.1186/s12885-022-09394-7

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The Twente Photoacoustic Mammoscope 2: 3D vascular network visualization

Photons Plus Ultrasound: Imaging and Sensing 2021 (2019)

Sjoukje M. Schoustra Roeland Huijink Laurens Alink Tim J. P. M. op 't Root Daan P. Sprünken

We present the Twente Photoacoustic Mammoscope 2 (PAM 2) based on a 3D tomographic geometry. A functional optical contrast map of breast vascularization can be obtained in a noninvasive, radiation-free and painless manner. A woman lies prone on a bed with one breast pendant in an imaging tank with water, where 12 curved ultrasound arrays are mounted. Each array extends from chest wall towards the nipple following the contour of the pendant breast, and carries 32 detector elements. The detectors' center frequency is 1 MHz. The breast is illuminated from multiple directions: the ventral side of the breast from the bottom and the areas close to the chest wall from the sides. The excitation wavelengths are 755 nm and 1064 nm. By rotating the imaging tank in between measurements, multiple projections can be obtained, providing a 3D image of the breast after reconstruction by means of a filtered backprojection. So far, breasts of healthy volunteers were imaged. Three-dimensional images of the breast contour, the nipple and blood vessel networks within the breast could be observed with high contrast and unprecedented detail.

10.1117/12.2507448

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Citations (6)