A fiber optoacoustic guide with augmented reality for precision breast-conserving surgery

Lu Lan; Yan Xia; Rui Li; Kaiming Liu; Jieying Mai; Jennifer Anne Medley; Samilia Obeng-Gyasi; Linda K. Han; Pu Wang; Ji-Xin Cheng

doi:10.1038/s41377-018-0006-0

Go to Nature Website

Your Location：

Home >

Browse articles >

A fiber optoacoustic guide with augmented reality for precision breast-conserving surgery

Original Articles

- A fiber optoacoustic guide with augmented reality for precision breast-conserving surgery
- Light: Science & Applications Vol. 7, Issue 4, Pages: 41-51(2018)
- Affiliations：
  
  1.Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215, USA
  2.Vibronix, Inc., 1281 Win Hentschel Boulevard, West Lafayette, IN 47906, USA
  3.Department of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907, USA
  4.Department of Precision Instrument, Tsinghua University, Beijing 10084, China
  5.Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd, Indianapolis, IN 46202, USA
  6.Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Indianapolis, IN 46202, USA
  7.Parkview Cancer Institute, 11109 Parkview Plaza Drive, Fort Wayne, IN 46845, USA
  8.Department of Electrical & Computer Engineering, Boston University, 8 Saint Mary's Street, Boston, MA 02215, USA
- Author bio：
  
  Linda K. Han (linda.han@parkview.com)
  Pu Wang (puwang@vibronixinc.com)
  J-X. Cheng (jxcheng@bu.edu)
- Funds：
- DOI：10.1038/s41377-018-0006-0
  CLC：
- Published：2018，
  
  Published Online：18 May 2018，
  
  Received：15 October 2017，
  
  Revised：07 February 2018，
  
  Accepted：07 February 2018
- Accepted：
Scan QR Code
Lan, L. et al. A fiber optoacoustic guide with augmented reality for precision breastconserving surgery. Light: Science & Applications, 7, 41-51 (2018).
DOI：

Lan, L. et al. A fiber optoacoustic guide with augmented reality for precision breastconserving surgery. Light: Science & Applications, 7, 41-51 (2018). DOI： 10.1038/s41377-018-0006-0.

摘要

Abstract

Lumpectomy

also called breast-conserving surgery

has become the standard surgical treatment for early-stage breast cancer. However

accurately locating the tumor during a lumpectomy

especially when the lesion is small and nonpalpable

is a challenge. Such difficulty can lead to either incomplete tumor removal or prolonged surgical time

which result in high re-operation rates (~25%) and increased surgical costs. Here

we report a fiber optoacoustic guide (FOG) with augmented reality (AR) for sub-millimeter tumor localization and intuitive surgical guidance with minimal interference. The FOG is preoperatively implanted in the tumor. Under external pulsed light excitation

the FOG omnidirectionally broadcasts acoustic waves through the optoacoustic effect by a specially designed nano-composite layer at its tip. By capturing the acoustic wave

three ultrasound sensors on the breast skin triangulate the FOG tip's position with 0.25-mm accuracy. An AR system with a tablet measures the coordinates of the ultrasound sensors and transforms the FOG tip's position into visual feedback with < 1-mm accuracy

thus aiding surgeons in directly visualizing the tumor location and performing fast and accurate tumor removal. We further show the use of a head-mounted display to visualize the same information in the surgeons' first-person view and achieve hands-free guidance. Towards clinical application

a surgeon successfully deployed the FOG to excise a "pseudo tumor" in a female human cadaver. With the high-accuracy tumor localization by FOG and the intuitive surgical guidance by AR

the surgeon performed accurate and fast tumor removal

which will significantly reduce re-operation rates and shorten the surgery time.

关键词

Keywords

references

American Cancer Society.Cancer Facts & Figures(2015), citation date (5 October 2017) and revised date (5 January 2018).http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdfhttp://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf..

Fisher, B. et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.N. Engl. J. Med.347, 1233–1241 (2002)..

van Dongen, J. A. et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European organization for research and treatment of cancer 10801 trial.J. Natl. Cancer Inst.92, 1143–1150 (2000)..

Veronesi, U. et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.N. Engl. J. Med.347, 1227–1232 (2002)..

Siegel, R. L., Miller, K. D.&Jemal, A. Cancer statistics, 2015.CA Cancer J. Clin.65, 5–29 (2015)..

Atkins, J. et al. Positive margin rates following breast-conserving surgery for stage Ⅰ–Ⅲ breast cancer: palpable versus nonpalpable tumors.J. Surg. Res.177, 109–115 (2012)..

Balch, G. C. et al. Accuracy of intraoperative gross examination of surgical margin status in women undergoing partial mastectomy for breast malignancy.Am. Surg.71, 22–28 (2005)..

Fleming, F. J. et al. Intraoperative margin assessment and re-excision rate in breast conserving surgery.Eur. J. Surg. Oncol.30, 233–237 (2004)..

Huston, T. L., Pigalarga, R., Osborne, M. P.&Tousimis, E. The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery.Am. J. Surg.192, 509–512 (2006)..

Li, R. et al. Assessing breast tumor margin by multispectral photoacoustic tomography.Biomed. Opt. Express6, 1273–1281 (2015)..

Postma, E. L., Witkamp, A. J., van den Bosch, M. A. A. J., Verkooijen, H. M.&van Hillegersberg, R. Localization of nonpalpable breast lesions.Expert. Rev. Anticancer. Ther.11, 1295–1302 (2011)..

Ahmed, M.&Douek, M. Intra-operative ultrasound versus wire-guided localization in the surgical management of nonpalpable breast cancers: systematic review and meta-analysis.Breast Cancer Res. Treat.140, 435–446 (2013)..

Rahusen, F. D. et al. Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: a randomized clinical trial.Ann. Surg. Oncol.9, 994–998 (2002)..

McGhan, L. J. et al. Radioactive seed localization for nonpalpable breast lesions: review of 1, 000 consecutive procedures at a single institution.Ann. Surg. Oncol.18, 3096–3101 (2011)..

Dauphine, C. et al. A prospective clinical study to evaluate the safety and performance of wireless localization of nonpalpable breast lesions using radiofrequency identification technology.Am. J. Roentgenol.204, W720–W723 (2015)..

Reicher, J. J., Reicher, M. A., Thomas, M.&Petcavich, R. Radiofrequency identification tags for preoperative tumor localization: proof of concept.Am. J. Roentgenol.191, 1359–1365(2008)..

Dayton, A. L. et al. Light-guided lumpectomy: device and case report.J. Biomed. Opt.15, 061706 (2010)..

Welch, H. G., Prorok, P. C., O'Malley, A. J.&Kramer, B. S. Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness.N. Engl. J. Med.375, 1438–1447 (2016)..

Hansen, C., Wieferich, J., Ritter, F., Rieder, C.&Peitgen, H. O. Illustrative visualization of 3D planning models for augmented reality in liver surgery.N. Engl. J. Med.5, 133–141 (2010)..

Inoue, D. et al. Preliminary study on the clinical application of augmented reality neuronavigation.J. Neurol. Surg. A74, 71–76 (2013)..

Rahman, O. F., Nahabedian, M. Y.&Sinkin, J. C. Augmented reality and wearable technology in image-guided navigation and preoperative planning.Plast. Reconstr. Surg. Glob. Open4, e1057 (2016)..

Ealo J. L. et al. Customizable field airborne ultrasonic transducers based on electromechanical film. InProc. IEEE Ultrasonics Symposium; Beijing, 2–5 November 2008; 879–882 (IEEE, Beijing, 2008).

Alkoy, S. et al. Miniature piezoelectric hollow sphere transducers (BBs).IEEE Trans. Ultrason. Ferroelectr. Freq. Control44, 1067–1076 (1997)..

Alles, E. J., Noimark, S., Zhang, E., Beard, P. C.&Desjardins, A. E. Pencil beam all-optical ultrasound imaging.Biomed. Opt. Express7, 3696–3704 (2016)..

Baac, H. W. et al. Carbon nanotube composite optoacoustic transmitters for strong and high frequency ultrasound generation.Appl. Phys. Lett.97, 234104 (2010)..

Liberman, L., LaTrenta, L. R.&Dershaw, D. D. Impact of core biopsy on the surgical management of impalpable breast cancer: another look at margins.Am. J. Roentgenol.169, 1464–1465 (1997)..

Xu, G. et al. Photoacoustic spectrum analysis for microstructure characterization in biological tissue: a feasibility study.Appl. Phys. Lett.101, 221102 (2012)..

Allen T. J., Cox B. T.&Beard P. C. Generating photoacoustic signals using high-peak power pulsed laser diodes.Proc. Volume 5697, Photons Plus Ultrasound: Imaging and Sensing 2005: the Sixth Conference on Biomedical Thermoacoustics, Optoacoustics, and Acousto-optics; San Jose, CA, USA; 25 April 2005; 233–242 (SPIE, San Jose, CA, 2005).

Li, C. P., Duric, N., Littrup, P.&Huang, L. J. In vivo breast sound-speed imaging with ultrasound tomography.Ultrasound Med. Biol.35, 1615–1628 (2009)..

Rosen, E. L., Sickles, E.&Keating, D. Ability of mammography to reveal nonpalpable breast cancer in women with palpable breast masses.Am. J. Roentgenol.172, 309–312 (1999)..

Uzzo, R. G.&Novick, A. C. Nephron sparing surgery for renal tumors: indications, techniques and outcomes.J. Urol.166, 6–18 (2001)..

Hong, S. N. et al. Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function.J. Clin. Gastroenterol.39, 247–252 (2005)..

Lanfranco, A. R., Castellanos, A. E., Desai, J. P.&Meyers, W. C. Robotic surgery: a current perspective.Ann. Surg.239, 14–21 (2004)..

Views

Downloads

CSCD

Alert me when the article has been cited

Submit

Tools

Publicity Resources

No data

Related Author

No data

Related Institution

No data

⁰