Navigated tissue characterization during skin cancer surgery
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ORIGINAL ARTICLE
Navigated tissue characterization during skin cancer surgery Natasja N. Y. Janssen1 · Martin Kaufmann2 · Alice Santilli1 · Amoon Jamzad1 · Kaitlin Vanderbeck3 · Kevin Yi Mi Ren3 · Tamas Ungi1 · Parvin Mousavi1 · John F. Rudan2 · Doug McKay2 · Ami Wang3 · Gabor Fichtinger1 Received: 11 January 2020 / Accepted: 18 May 2020 © CARS 2020
Abstract Purpose Basal cell carcinoma (BCC) is the most commonly diagnosed skin cancer and is treated by surgical resection. Incomplete tumor removal requires surgical revision, leading to significant healthcare costs and impaired cosmesis. We investigated the clinical feasibility of a surgical navigation system for BCC surgery, based on molecular tissue characterization using rapid evaporative ionization mass spectrometry (REIMS). Methods REIMS enables direct tissue characterization by analysis of cell-specific molecules present within surgical smoke, produced during electrocautery tissue resection. A tissue characterization model was built by acquiring REIMS spectra of BCC, healthy skin and fat from ex vivo skin cancer specimens. This model was used for tissue characterization during navigated skin cancer surgery. Navigation was enabled by optical tracking and real-time visualization of the cautery relative to a contoured resection volume. The surgical smoke was aspirated into a mass spectrometer and directly analyzed with REIMS. Classified BCC was annotated at the real-time position of the cautery. Feasibility of the navigation system, and tissue classification accuracy for ex vivo and intraoperative surgery were evaluated. Results Fifty-four fresh excision specimens were used to build the ex vivo model of BCC, normal skin and fat, with 92% accuracy. While 3 surgeries were successfully navigated without breach of sterility, the intraoperative performance of the ex vivo model was low (< 50%). Hypotheses are: (1) the model was trained on heterogeneous mass spectra that did not originate from a single tissue type, (2) during surgery mixed tissue types were resected and thus presented to the model, and (3) the mass spectra were not validated by pathology. Conclusion REIMS-navigated skin cancer surgery has the potential to detect and localize remaining tumor intraoperatively. Future work will be focused on improving our model by using a precise pencil cautery tip for burning localized tissue types, and having pathology-validated mass spectra. Keywords Model-guided surgery · Optical navigation · Intraoperative surgical resection margin assessment · Real-time tissue characterization
Background
Natasja N. Y. Janssen and Martin Kaufmann have contributed equally to this work.
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Natasja N. Y. Janssen [email protected]
1
School of Computing, Queen’s University, Kingston, ON, Canada
2
Department of Surgery, Queen’s University, Kingston, ON, Canada
3
Department of Pathology, Queen’s University, Kingston, ON, Canada
Attributed to increasing exposure to solar radiation and the aging population, the incidence of basal cell carcinoma (BCC) has reached 2.75 millio
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